BY NORM TOLLINSKY

Dr. Gabriel Mapeso, a surgeon at Thunder Bay Regional Health Sciences Centre, remembers how excited he was when he got his first 1.5-megapixel digital camera. Now, it sits abandoned in a drawer somewhere, replaced by a 10-megapixel camera.

A laparoscopic surgeon, Mapeso, uses the analogy to describe what it’s like operating in the hospital’s new, fully integrated, minimally invasive high definition surgical suites.

“When we got our first laparoscope, we were so excited. We could see inside the body, but with the improved definition and clarity of our new minimally invasive surgical suites (MIS), it’s just amazing,” he said.

Mapeso would never go back to using his1.5-megapixel camera and would be similarly reluctant to return to using earlier generation laparoscopic technology.

The first, fully-integrated, minimally invasive surgical suites in Canada with true high definition (1080p) picture quality provide surgeons in Thunder Bay with crisp, clear images on wide-screen monitors to guide their endoscopic instruments.

Acquired and commissioned in April at a cost of between $300,000 and $400,000 per room, the MIS suites are already heavily booked.

“I hope we can raise funds for another two rooms because we’re already fighting over them,” said Mapeso.

Cholecystectomies, or gall bladder removals, the most common application of laparoscopic surgery, require a one-centimeter incision.

“For bigger organs, you have to plan for an exit site,” said Mapeso. “A bowel can come out a one-inch to 2.5-inch incision. For larger organs such as an enlarged spleen, we usually morselate it, or mince it up, put it in a bag, crush it and suction it off, but we don’t do that for the bowel or in situations where you have to take the organs out intact to identify the pathology, especially if it’s cancer.”

The MIS suites can also be used for lung resections and to remove kidneys.

The abdomen is inflated using carbon dioxide gas and the laparoscope with video camera and light source is inserted through a small incision into the abdominal or pelvic cavities. Other endoscopic instruments, including graspers, dissectors, scissors, needle holders and cautery instruments are inserted through additional keyholes.

Smaller incisions speed recovery time and result in less pain for the patient, said Mapeso.

“There’s an up-front cost because of the investment in the MIS suite and the cost of the instruments, but the benefit is that you’re able to discharge patients earlier and free up hospital beds.

“If you have your gall bladder taken out the open way, you’ll be in hospital for several days. If I take it out using the laparoscope, you’re discharged the same day.”

In fact, some of Mapeso’s patients tell him jokingly that they wasted their money on pain medication he prescribed because they never had to use it.

Doing laparoscopic surgery using older technology required hospital staff to wheel carts with all of the equipment and monitors into a conventional OR.

“There were wires spilling all over the floor,” said Mapeso. “Now, everything is hanging from the ceiling on booms. The operating rooms are built in such a way that there are huge steel beams overhead, so you can hang a dump truck from the ceiling if you want to.”

Digital video from laparoscopic and overhead cameras can be mounted on large wide-screen monitors, recorded, stored and retrieved for training and mentoring purposes.
“We can burn video to a DVD or transmit it over the Internet to a classroom or to an operating room at another hospital,” said Mapeso.

“In the future, for example, if I want to have a consultation with a laparoscopic guru in Hamilton or Toronto, I can connect to his OR and he can teach me.”

The technology can also be used in the future to perform operations telerobotically.

Mapeso, who is originally from the Philippines, trained at Memorial University in Newfoundland and joined the staff at Thunder Bay Health Sciences Centre 12 years ago.

Editor’s note: a video of a cholecystectomy, or gall bladder removal, using laparoscopic surgery is available for viewing at www.youtube.com/watch?v=lC07fy0swz4