Men's Health: Surgery Techniques
April 27, 2001 -- In case you're among the one in four men who will go under the knife this year, read this to make sure the doctor actually needs to use one.
The Problem: You Have a Cancerous Tumor in Your Prostate
Old surgery: Open prostatectomy.
New surgery: Laparoscopic radical prostatectomy.
Surgical removal of the prostate is no longer the only option for men with localized prostate cancer. Surgeons at the Cleveland Clinic have begun performing a laparo-scopic procedure that uses just five tiny holes to remove the cancerous gland.
The surgeon inserts a small lighted camera and miniature cutting tools, then cuts the prostate and draws it out.
The new procedure leaves tiny scars, means just one day of chipped beef from the hospital canteen, and keeps you away from the gym for only two weeks instead of the usual eight.
"Because it's only minimally invasive, this treatment may become the surgical procedure of choice for men with cancer confined to the prostate gland," says Dr. Craig D. Zippe, a urologic surgeon at the clinic.
Ask your doctor if you're a candidate for the procedure, which costs about $17,500, compared with $19,000 for the old one, according to Zippe.
The Problem: Your Arthritic Knees are Completely Shot
Old surgery: Total knee replacement
New surgery: Unicompartmental knee arthroplasty
Fifteen years ago, steel knee-joint replacements gave new mobility to men who couldn't walk the dog without taking a palmful of pain medication.
But the 6-hour surgery created foot-long scars that would frighten Frankenstein author Mary Shelley, and left recipients with movements like her monster.
This new procedure replaces only the diseased bone (with steel) and damaged cartilage (with plastic). Once installed, these new parts move easily against one another, reducing pain and increasing range of motion.
And since only part of the joint is replaced, the incision is a mere 3 inches long, which cuts recovery time from four months to one.
"Men can even go back to biking and skiing — sports that were impossible after the older surgery," says Dr. Mitchell Sheinkop, an orthopedic surgeon at Rush-Presbyterian-St. Luke's Medical Center in Chicago, and the first surgeon to use the new procedure.
Unicompartmental knee arthroplasty won't be widely available until June, but it's worth the wait. At $15,000 per knee, it's half the cost of a complete joint replacement, says Sheinkop, but should last just as long — about 15 years.
The Problem: Your Shoulder Popped Out of Joint
Old surgery: Open capsular shift
New surgery: Thermal capsular shrinkage
Shoulder ligaments are like the waistband in a pair of old underwear: Once they're stretched out, they're never the same.
That's why doctors usually choose to operate (on the ligaments, that is), says Dr. John Bergfeld, an orthopedic surgeon at the Cleveland Clinic.
Until recently, this meant trimming the frayed ligaments, pulling them taut, and sewing them back together.
This made the shoulder joint tight again, but recovery time was six months or longer, and the shoulder would regain only 70 percent of its original flexibility.
Now doctors can repair this condition by simply inserting a small probe into the joint and heating the ligaments with radio frequencies. The heat shrinks the ligaments like a wet wool sweater in a hot dryer, tightening them into place.
The procedure, at $7,000, is half the cost of the previous operation, Bergfeld says. It's done on an outpatient basis, so you'll be home in a few hours and as good as new in about 16 weeks.
The Problem: Your Aorta Has a Frightening Bulge
Old surgery: Open aortic aneurysm repair
New surgery: Endovascular therapy
An aortic aneurysm, a life-threatening bulging of the main artery in the abdomen, used to be treated with major invasive surgery.
But this new operation is less painful and cuts recovery time by months, says Dr. Ted Kohler, chief of vascular surgery at the Veterans Administration Puget Sound Health Care System in Seattle.
With the new procedure, instead of making a large abdominal incision and splicing in a Dacron (synthetic) tube, the surgeon folds a polyester- and wire-mesh graft into a thin tube, inserts it into an artery in the groin, and threads it up to the aorta.
Once it's guided into place, it expands against the inside wall, strengthening the artery and preventing a rupture in the weak spot.
The patient will be out of the hospital in two days instead of seven, and back at full throttle in six weeks instead of three months, says Kohler.
Other advantages: The new surgery is done using a lighter anesthetic, and results in less blood loss, less time in the intensive-care unit, and a quicker return of bowel function. One disadvantage: It's a third more expensive than the older surgery.
The Problem: One of Your Coronary Arteries Is Blocked
Old surgery: Angioplasty
New surgery: Coronary artery stent
Surgeons have been performing angioplasties for years, opening clogged coronary arteries by inflating balloons inside them.
But how do you prevent those arteries from reclogging? In this new procedure, surgeons implant a stent — a wire-mesh tube that looks like the Chinese finger traps you played with as a kid.
The stent becomes a scaffold in the artery and works to prevent the recurrent narrowing prevalent in 20 percent to 40 percent of angioplasty cases.
Though they're not foolproof — the stent Vice President Dick Cheney received last November failed to prevent some re-narrowing, and he ended up in the hospital in early March — experts say stents are a major step forward in heart health.
"This is the single most important non-drug advancement in heart treatment in the past two decades," says Dr. Gregg Stone, of the Cardiovascular Research Foundation in New York City.
The Problem: You Have a Herniated Disk
Old surgery: Posterior fusion
New surgery: Anterior cage fusion
More than 10,000 American men will have disk surgery this year. The operations are brought on by spinal injury or by deterioration of the disks — the slivers of cartilage that act as cushions between your vertebrae.
When a disk slips out of place, it can press on nerves, causing numbness, pain, or, in severe cases, paralysis.
The most common way to surgically treat "slipped disks" has been to remove them.
In more complicated cases in which fusion is necessary, the area is reinforced with steel rods and screws.
This operation fixes the problem, but it is expensive (roughly $45,000), requires a week in the hospital, and necessitates up to eight months of rehabilitation — and frequent strip searches at airport metal detectors.
In a new procedure, doctors implant hollow titanium cylinders packed with grafted bone into the disk space, by way of a small incision in the abdomen.
In just a few months the bone fuses with the vertebrae above and below, stabilizing the area and allowing more flexibility than the screw-and-rod treatment. The operation means just two days in the hospital, and you can be working out in less than six weeks, says Dr. Scott Blumenthal, a spine surgeon at the Texas Back Institute.
The Problem: You Snapped a Big Bone
Old surgery: Open bone plating.
New surgery: Minimal incision bone plating
Break a femur, the big bone in your thigh, or a tibia, your shinbone, and it's a long road back.
First you'll undergo surgery that requires the doctor to cut down the length of the bone and insert a metal plate for support.
Next you'll have eight to 10 weeks on crutches. Finally, you'll go through 12 to 24 weeks of rehabilitation to beef up atrophied muscles.
Half a year later you're back where you started — only with a long zipperlike souvenir of that ski trip.
Using this new procedure, surgeons make several mini incisions near the end of the fractured bone site and insert metal plates, slipping them under the muscles and against the bone.
Then mini incisions are made to insert the screws through the plates. These plates are designed to support the broken bone and increase bloodflow to the break, which will promote healing.
The operation is less invasive, less painful, and less likely to cause infection; and it shortens the average hospital stay from three days to one.
"The patient simply returns to normal more quickly," says Dr. Bruce D. Browner, a professor of orthopedic surgery at the University of Connecticut Health Center in Farmington.