Minimally Invasive Surgery

Specializing Institutions

Minimally invasive surgery, also called laparoscopic surgery, allows surgeons to operate on patients using small precision instruments that minimize pain, scaring, blood loss and recovery time. During these procedures, doctors make one or more incisions, each about a half-inch long, to insert a tube. The number of incisions depends on the type of surgery. The tubes allow the doctors to slip small video cameras and other specially designed surgical instruments for the procedure. Depending on your condition, you may need only a short hospital stay. Conditions that can be treated with minimally invasive surgery include, LAP-BAND Surgery, Hernia Surgery, Anti-Reflux Surgery, Adrenal Surgery, Hysterectomy and Ulcerative Colitis.

Institutions at the South Texas Medical Center offer non-invasive surgery performed with the latest medical equipment by da Vinci technology and Gamma Knife. Thanks to this breakthrough surgical technology patients can receive effective, minimally invasive alternatives to both open surgery and laparoscopy. The da Vinci Surgical System helps surgeons in procedures that treat a range of conditions, such as Bladder Cancer, Colorectal Cancer, Coronary Artety Disease, Endometriosis, Obesity, Thyroid Cancer, Kidney Disorders, Uterine Fibrosis and more.

The South Texas Medical Center also offers alternatives to open heart surgery that have many advantages over traditional surgery. The da Vinci Surgical System provides surgeons and patients with an effective and minimally invasive treatment to even the most complex cardiothoracic procedures such as mitral valve repair. Non-invasive surgeries reduce the risk of infection, minimize blood loss, shorten the hospital stay, leave less scaring and lead to faster recovery. Institutions at the South Texas Medical Center also offer Hysterectomy, Gynecologic and Prostatectomy surgeries using the da Vinci Surgical System.

Patients can also find a newer, less invasive treatment for Craniosynostosis at the South Texas Medical Center, where the founders of Endoscopic Craniectomy have been working in the last twelve years to help hundreds of children grow up to live a normal life.

The most accurate and advanced version of Gamma Knife radiosurgery is also available at the South Texas Medical Center. Surgeons at our institutions have dramatically increased the precision of radiation delivery during surgery while improving the comfort for patients with this non-invasive treatment. Gamma Knife radiosurgery is used to treat tumors and lesions in the brain.

Surgery Articles

  • Robot bladder surgery fails to deliver fewer complications

    By Gene Emery

    NEW YORK (Reuters Health) - Using robotic techniques to remove a cancerous bladder doesn't reduce the risk of complications compared with conventional "open" surgery, according to a new comparison of 118 patients conducted by surgeons at the Memorial Sloan Kettering Cancer Center in New York.

    The study, detailed in the New England Journal of Medicine, marks the first ongoing comparison of the risks and benefits of the two techniques. Past studies concluded that the robotic technique meant less time in the hospital and fewer complications but they were done by looking back at the records of already-treated patients.

    "There's been a lot of hype surrounding robots and it's been hard to gain perspective," said Dr. Vincent Laudone, one of the coauthors.

    Dr. Jennifer Yates, director of minimally invasive urology at the University of Massachusetts Medical School, who was not involved in the test, told Reuters Health that the findings will give surgeons pause because they're going to be surprised by the results.

    Robots have shown to be so valuable for prostate removal, many surgeons were convinced that a similar benefit would appear when they were used for bladder removal, she said. "They're going to say, 'Hey, I'm kinda surprised by this.' They're also going to be encouraged that the complication rate was comparable."

    "Bottom line: It looks like it was pretty much a wash," Laudone told Reuters Health. For patients, it means "if you're going to a surgeon who is experienced in traditional surgery and recommends traditional surgery, that's a reasonable recommendation."

    He estimated that perhaps 25 percent of bladder cancer removals, known as radical cystectomies, are currently done with robots.

    The study also found that patients who underwent conventional surgery spent about 28 percent less time in the operating room. They experienced more blood loss - about 5 ounces more - but "with that amount, we wouldn't expect to see any significant side effect," Laudone said.

    "These results highlight the need for randomized trials to inform the benefits and risks of new surgical technologies before widespread implementation," he and his colleagues concluded.

    About 67,000 bladder tumors are discovered in the U.S. each year and one quarter of them require bladder removal.

    The new study involved patients who needed both the bladder and nearby lymph nodes extracted. The men also lost their prostate and the women lost their ovaries, fallopian tubes, uterus and related organs. Even when a $2 million robot was used, conventional surgery was employed to redirect urine to the intestine.

    With robot-assisted surgery, 22 percent of the 60 patients had at least one serious complication within the first 90 days. A complication was regarded as serious if it required further surgery, intubation or major rehabilitation. The rate was essentially the same - 21 percent - with traditional surgery.

    When the researchers included lesser complications, such as those requiring intravenous medicine or blood transfusion, the risk was 62 percent with robot-assisted surgery versus 66 percent with open surgery.

    The average length of hospital stay was eight days for both groups.

    But the patients in the robot group spent two hours longer in the operating room. The average time was 5 hours 29 minutes with conventional surgery and 7 hours 36 minutes with robotic assistance.

    Both Laudone and Yates said that time difference is expected to shrink as doctors become more adept at working with robots.

    "It's an evolving technology and we're evolving in our learning to use the robot," Laudone said. "We're getting better as robotic surgeons, so operating time is diminishing. With prostate surgery, the same thing was true. Now, in some cases, doing it with the robot is faster. So the time difference is something I think will disappear with more experience."

    Yates cautioned that "this was a small study and I think it needs to be fleshed out with larger numbers. And you have to remember that Sloan Kettering is one of the more prominent high-volume institutions in the country. Whether this is generalizable to other institutions remains to be seen."

    SOURCE: New England Journal of Medicine, online July 23, 2014.

  • Fourth bacterial infection death reported at South Carolina hospital

    By Harriet McLeod

    CHARLESTON, S.C. (Reuters) - A patient who contracted a rare bacterial infection during surgery at a South Carolina hospital died last week, bringing the total deaths to four since the outbreak was first suspected in May, a hospital spokeswoman said on Tuesday.

    The four dead are among 15 patients infected by Mycobacterium abscessus during surgery at Greenville Memorial Hospital, spokeswoman Sandy Dees said.

    Hospital officials cited tap water as the likely origin of the bacteria.

    "Although we use sterile water in or near the surgical sterile field, even something as seemingly safe as pre-surgery hand washing may have contributed," said Dr. Robert Mobley Jr., the hospital's medical director of quality. "At this time, we have not been able to find any single cause or process as the trigger for the outbreak."

    Mycobacterium abscessus is commonly found in soil, water and dust, but rarely causes infection in healthy people, hospital officials said.

    Infection is usually caused by injections of contaminated substances or by invasive medical procedures using contaminated equipment or material, according to the U.S. Centers for Disease Control and Prevention.

    Mycobacterium abscessus associated with healthcare can cause infections of the skin and soft tissues under the skin or lung infections in people with chronic lung diseases, the CDC said.

    The first patient tested positive for the infection in March, and two of the infected surgical patients remained hospitalized, Dees said. All the infected patients had serious underlying medical conditions, she said.

    After an investigation assisted by the CDC and South Carolina's health agency, the hospital has started using new operating room procedures, including filtering water and flushing scrub sinks, Dees said.

  • Pregnancy doesn't drive women doctors out of surgical training

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

    Researchers led by Dr. Erin G. Brown of the University of California, Davis found that neither women nor men who had children born during their school's surgical residency program were more likely to quit than residents who did not have children during training.

    Brown told Reuters Health the idea for the study came to her when she was pregnant with her daughter, now one and a half years old, during her surgical residency.

    "Things are changing. It's not an overnight change. It's a slow, steady culture change away from the old boys' club mentality that women who have children during training aren't going to cut it," she said.

    "This study shows that surgical residents who have children during training are just as good," she added.

    General surgical residency programs last five years and are known for being rigorous.

    For the new study, Brown and her colleagues reviewed records on 85 residents enrolled in the University of California, Davis general surgery residency program from 1999 to 2009.

    Forty-nine of the residents were men, and the average age of all residents entering the program was almost 28 years. Overall attrition was about 19 percent, with 16 residents leaving the program.

    A similar proportion of male and female residents left the training program.

    Of the 85 residents, 25 had children born during training.

    Among female residents in particular, 25 percent had children during training and took an average maternity leave of 10 weeks. One of those women left the training program. One woman extended her residency training by two weeks, but the other women who had babies while in training completed the program on time.

    Residents with children born during the program treated a similar number of patients and were equally likely to pass their boards as those who did not have children, according to findings published in JAMA Surgery.

    In an accompanying commentary, Dr. Jeffrey Gauvin, director of the surgical training program at Santa Barbara Cottage Hospital in California, applauded the study but questioned its applicability to smaller programs like his own.

    Davis has "a deep bullpen from which a program director can call in reserves when someone is on leave," he writes. "This may be a very different scenario for small or midsized programs that have very limited - if any - reserves."

    Gauvin formerly directed the surgical residency program at the University of California, Davis.

    Brown acknowledged that smaller programs could face greater challenges in accommodating surgical residents during maternity leave. She is currently compiling data from surgical residency programs of various sizes across the nation to see if the results of the Davis study hold.

    "These are very motivated women who know what they want, and they're able to manage the stress of parenting and training and don't deviate from their career goals," Brown said.

    Women comprised just seven percent of U.S. medical school graduates in 1965, according to the Association of American Medical Colleges. Today that rate hovers near 50 percent.

    But a majority of surgical residents continue to be male, Dr. Nina Shapiro told Reuters Health.

    Shapiro, a professor of head and neck surgery at the University of California, Los Angeles, was not involved in the current study. She said she has watched life change for pregnant surgical residents since she began her training in 1991.

    "Because there's been an increase in the number of women, the climate has by default changed," she said. "There's a huge difference in 20 years."

    "The women going into surgery are very keenly watching those ahead of them. If women are showing they can have babies and be successful, I think other women are going to follow. It's really inspiring for women going into these training programs."

    Shapiro is married to another physician, and they have two young children.

    "Is it a perfect life?" she asked. "There are many days I can't see my kids. For the most part, I make it work. I never miss a school event, a big event in my kids' lives. I don't miss too many small events. I do a lot of homework. I know a lot of fifth-grade math."

    SOURCE: and JAMA Surgery, online July 16, 2014.