Posts Tagged ‘surgery’

Michael DeBakey dies at 99

Saturday, July 12th, 2008

–Houston Chronicle, ‘Dr. Michael DeBakey: 1908-2008 — ‘Greatest surgeon of the 20th century’ dies’: ‘Dr. Michael Ellis DeBakey, internationally acclaimed as the father of modern cardiovascular surgery – and considered by many to be the greatest surgeon ever – died Friday night at The Methodist Hospital in Houston. He was 99. Methodist officials said DeBakey died of natural causes. They gave no additional details.

‘Medical statesman, chancellor emeritus of Baylor College of Medicine, and a surgeon at The Methodist Hospital since 1949, DeBakey trained thousands of surgeons over several generations, achieving legendary status decades before his death. During his career, he estimated he had performed more than 60,000 operations. His patients included the famous – Russian President Boris Yeltsin and movie actress Marlene Dietrich among them – and the uncelebrated.’

DeBakey was an amazing pioneer in surgery. In 1938, he and his mentor, Alton Ochsner, published an article on the drainage of subphrenic abscess, a surgical plague in the days before antibiotics. Patients with perforated appendicitis were kept in the hospital for weeks in “Fowler’s position,” to avoid the dreaded complication of subphrenic abscess. Fowler’s position, inadequately explained in that Wikipedia article, was a seated position in bed to allow pus to drain into the pelvis where it could be drained through the rectum or, in females, through the vagina. Before DeBakey’s and Ochner’s article, the approach to a subphrenic abscess, above the liver and below the diaphragm, was extremely dangerous. It was also common because lying flat in bed tended to allow pus to flow up to the space above the liver. They found that the space could be drained through an approach through the 11th rib. It was easy and effective in the days before antibiotics made subphrenic abscess rare. He should be famous for that alone. The rest of his career will be covered extensively by others but I fear his first great contribution may be ignored. He was a great man.

Another surgical innovation ?

Tuesday, April 22nd, 2008

Today, I read about a new approach to abdominal surgery that had never occurred to me before. It is called “NOTES” or Natural Orifice Transluminal Surgery, and the application being described is removing the gallbladder through the mouth. Why anyone would want to do that is a mystery to me. Laparoscopic surgery was a huge advance, both for patients’ comfort and, once the learning curve was behind, for safety and postop recovery. The trans-gastric approach seems awfully difficult. The Wall Street Journal refers to trans-vaginal surgery, which has been a preferred method for some procedures for many decades. Hysterectomy and tubal ligation are two examples.

There are other examples of this sort of approach. For example, the pituitary gland is usually approached through the nose. The maxillary sinus is approached through the mouth going above the upper teeth. Both of these routes avoid scarring and are the most direct. There are also trans-anal approaches to some types of rectal tumors and drainage of pelvic abscess can also be done very easily by that route. Once again, it is the most direct and avoids a big incision. Another major operation done through a natural orifice is transurethral resection of the the prostate, or TURP. This and cystoscopy, examination of the urinary bladder by a scope introduced through the urethra, are the majority of urological surgery.

This trans-oral, trans-gastric approach to the gall bladder seems an awfully roundabout approach for little benefit. Laparoscopic surgery is hard enough to learn. This week I take my students to the Surgical Skills Center and we will see if we can do some laparoscopic simulation. I’ll have to see the other in action before I can get enthusiastic about it.