Laparoscopic surgery: ‘It’s an art’
Dr. Aziz Benbrahim uses laparoscopic surgery to remove a gallbladder.
Posted: 10 April 2009
MERIDEN — Kristy Levesque, a Berlin resident who is studying to become a nurse, spent a recent morning watching Dr. Aziz Benbrahim perform laparoscopic surgery in an operating room at MidState Medical Center. Benbrahim’s specialty is single-incision laparoscopy.
“It’s an art,” observed Levesque, as she watched Benbrahim operate to remove the gallbladder of a 19-year-old patient. An art because the surgeon has to manipulate instruments within a patient’s body while watching progress on a video screen, as opposed to, as she put it, “going right in there.”
Levesque was also aware of the advantages to the patient: less chance of infection, more rapid recovery.
“The guy they did earlier is going home this afternoon,” she said.
Benbrahim says he has yet to convince his local colleagues of the advantage of a single incision approach, which involves one cut below the belly button, over the more traditional method which employs three other abdomen area incisions and gives the surgeon a triangulating approach. There’s more skill involved, but Benbrahim considers it worth it. Benbrahim says he is anticipating the day when laparoscopic surgery will be performed without any cutting at all, but via entry through the body’s natural orifices.
Laparascopic surgery to remove the gallbladder was first done in France in 1985. The technique involves snaking a tiny video camera through a tube that has been inserted through the incision. The surgeon relies on the camera to guide his tools. Carbon dioxide gas is injected into the abdominal area to make for a larger space for viewing and working with organs.
The gallbladder is a sac located under the liver that stores bile not immediately needed for digestion. It’s one of the organs, like the appendix, that the body can do without, particularly if it’s causing trouble.
“We are designed as if we were meant to have the gallbladder out,” observed Benbrahim.
As it turned out the other morning, the young woman having her gallbladder removed is also studying to become a nurse. Samantha Schabel, a Durham resident, graduated from Middletown High School last year and now attends Middlesex Community College.
The symptoms that led her to the operating table included feeling ill immediately after she ate. Then, in recent weeks, it was feeling nauseated most of the time. Her mother, sister and grandmother all had their gallbladders removed. Ultrasound testing found no gall stones, but indicated that her gallbladder function was at just nine percent.
In performing the surgery on Schabel, Benbrahim encountered a complication almost from the onset, in the form of a large liver wrapped around a small gallbladder. He decided the other incisions of the more traditional approach would be needed.
“You don’t jeopardize the safety of the patient,” he said. “Do no harm, that’s the most important thing.”
An important consideration, said Benbrahim, is identifying the structures. The duct from the liver meets with the cystic duct at the common bile duct. Separating the gallbladder at the right spot in these roadways, so to speak, avoids further complications.
“In surgery, we say, the best surgery is the first one,” said Benbrahim, while physician’s assistant Michele Trinidad began stitching up the incision areas. The gallbladder was placed in a small plastic bag, to be sent to the lab for testing.
A few moments later, Benbrahim was talking with Schabel’s parents, Alan and Lisa Schabel, in one of the consulting rooms off MidState’s main concourse. Because of the complication, he wanted to keep Samantha in the hospital overnight before letting her return home. They spent a few moments chatting about the two horses Samantha takes care of there.
He explained that shoulder pain could ensue as a result of the inflation of the diaphragm by the carbon dioxide, but that if the same pain that Samantha had before the surgery returned they were to call him right away.
On the phone from home the day she returned from the hospital, Samantha Schabel said she was told she’d be back on her feet in a week. She said she would have preferred the single-incision method, but understood why it hadn’t worked out that way. She was looking forward to horseback riding again in two weeks.
Submitted by Jeff Kurz on Fri, 04/10/2009 - 17:26
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