Reducing risks of gallbladder and other operations with Canadian technology assembled in Richmond, BCMay 14, 2015. 12:15 pm • Section: Medicine Matters Reducing risks of gallbladder and other operations with Canadian technology assembled in Richmond, BC Posted on May 14, 2015 Posted on May 12, 2015 BY PAMELA FAYERMAN The University of BC Hospital is the first in Canada to use a new surgical imaging system from a local manufacturing facility in Richmond to help reduce risks of surgical complications during small-incision (laparoscopic) gallbladder surgery. Dr. Neely Panton, head of general surgery at both UBC and Vancouver General hospitals, said in an interview that a "test-drive" of the $150,000 technology developed by a Canadian company called Novadaq showed it is a significant advance. On a mobile cart that can move from one operating room to another, it combines camera-tipped surgical tools (inserted through small incisions) and a real-time image capturing system that allows surgeons to see critical organs, tissues and vessels that they don't want to accidentally nick during operations. Patients prefer small incision surgery because of reduced pain, faster recovery and smaller scars. But Panton said smaller incisions can make it more challenging for surgeons to see where they are working inside the abdominal cavity or anywhere else for that matter. So tools that enable better visualization of critical anatomical structures and blood flow are highly desirable. Said Panton: "The technology allows us to see the biliary tree and blood vessels, potentially preventing bile duct injuries which continues to be a rare, but serious problem, despite the fact that the surgery has been performed for over three decades." Minimally invasive gall bladder removal surgery is called laparoscopic cholecystectomy. "It's a nickel and dime operation with million dollar complications," Panton said, referring to the fact that it's such a common procedure (about 100,000 done/year in Canada) but pays surgeons a relatively low fee ($519). Meanwhile, if a mistake is made, grave consequences for the patient can ensue, including infections, internal bleeding and reconstruction surgery, not to mention longer stays in hospital. Some of the more serious complications include nicking the liver, small intestine or abdominal blood vessels. Bile duct injuries are said to occur less than one per cent of the time, but according to a provincial government resource (Healthlink), in five to 10 per cent of all gallbladder operations, surgeons have to make a bigger incision to either repair damage caused by surgical instruments or to get a better view of the operative area. The PINPOINT Endoscopic Fluorescence Imaging System – a Canadian innovation now being acquired by hospitals across North America, including the University of BC Hospital. Panton said inflammation and unexpected anatomical anomalies are sometimes factors in what makes usually straightforward procedures riskier. The Novadaq Pinpoint Endoscopic Fluorescence Imaging System is a high definition system with various lighting choices, depending on what part of the body surgeons want to highlight. The organs or tissues fluoresce (light up) after the patient is injected with a special dye called indocyanine green. The dye is used because it accumulates in the tissues surgeons want to see, is non-toxic, and is excreted entirely by the liver. Panton said five general surgeons used the equipment after it was loaned from the company for a one-month trial. During the trial period, 12 patients had scheduled gallbladder operations at UBC. Results of the pilot showed that most surgeons felt the technology gave them more confidence that they had a better view of the surgical field and that the technology allowed them to see anatomical structures clearly. If there was one complaint, it was that the administration of the intravenous dye used up a bit more time and doctors tried to figure out if it should be injected by anesthesiologists or the surgeons. Panton said only one of the five surgeons was uncertain about whether he would use the technology. He expects the indications for its use will expand. Plastic surgeons already use the technology when doing breast reconstruction. The equipment will be purchased by the VGH/UBC Hospital Foundation. Ongoing research will continue to explore whether it helps reduce surgical complications. Gagan Gill, the national sales manager for Novadaq, said while UBC Hospital is the first to use the technology for gallbladder surgery, there are four hospitals in Quebec and Ontario where it's being used for other types of operations. Over 100 hospitals in the United States have purchased it. There are about 60 employees, he said, at the Richmond facility, employed in research, development and engineering positions. The company was founded in Winnipeg but is now headquartered in Mississauga, Ontario. Sun Health Issues Reporter
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