Specialized surgery employs new approaches, technology


Brian Hinnebusch, MD & Atif Kahn, MD
6/5/2018

A walk past Emerson’s ten operating rooms reveals a range of surgeries underway, performed by the hospital’s general surgeons and a variety of specialists. They use new techniques, often supported by technology, and perform advanced procedures. In some cases, they perform under-utilized surgery that benefits patients.

Rectal Surgery

In joining Walden Surgical Associates this winter, Brian Hinnebusch, MD, brought his considerable clinical skills — notably in rectal surgery. “We can re-create the rectum when it needs to be resected in cases of low rectal cancer or ulcerative colitis,” says Dr. Hinnebusch. “These operations can be performed laparoscopically using a minimally invasive approach that results in the same success rates, with the added benefits of a more rapid recovery and return to normal activities while avoiding a permanent colostomy. Patients who undergo these sphincter-preserving operations have good functional results and an increased quality of life.”

Dr. Hinnebusch also performs transanal minimally invasive surgery in select patients with large polyps or very early-stage cancer. “This operation, which typically is performed as an outpatient procedure, does not cause pain and allows some patients to avoid complete removal of the rectum.”

Foregut Surgery

Laura Doyon, MD, a bariatric surgeon, has an interest in foregut surgery, which addresses reflux disease, swallowing disorders, hiatal hernias and Barrett’s esophagus. “My focus is on benign disease,” she says. “Foregut surgery requires the same skills as bariatric surgery, including laparoscopic suturing and fine technical work.”

In fact, 20-30 percent of bariatric surgery patients have hiatal hernias. “We perform those repairs at the same time as the weight loss procedure,” Dr. Doyon notes. “For patients with long-standing reflux disease who do not get relief with medication, surgery can help. Similarly, patients with large hiatal hernias who suffer from chest pain will benefit from surgery at Emerson, which typically requires a stay of less than 24 hours.”

Spine Surgery

Spine surgery used to make patients run the other way, but minimally invasive techniques that use the anterior approach, along with sophisticated technology in the operating room, have led to major advances. “Today we use the anterior approach to perform minimally invasive cervical fusion and discectomy,” says Robert Whitmore, MD, neurosurgeon. “It is much easier on the patient: almost same-day surgery, with very little pain.”

Patient outcomes have improved. “We use neuro-monitoring and, when needed, the operating microscope, to keep everything as safe as possible,” says Dr. Whitmore, who performs artificial disc replacement surgery when the disc is pushing into the nerve root. “For disc replacement, I mainly operate on young individuals with a relatively preserved disc to maintain motion. If someone has arthritis, fusion usually is indicated.”

In the lumbar spine, Dr. Whitmore uses a unilateral approach to performing laminectomies. “Special retractors and a microscope allow me to perform a full laminectomy from only one side of the spine. With this more minimally invasive approach, the spine remains more stable.”

Urologic Surgery

Since arriving at Emerson last fall, Jacqueline Brecht, MD, a urologist, has diagnosed and treated many patients with bladder problems. Given her interest in urinary symptoms, Emerson Urology Associates recently added a urodynamic testing center. “There are many reasons why a bladder can no longer contract,” she says. “Men may have prostate obstructions, and elderly people may have neurologic problems. Patients share a desire to avoid wearing a catheter, even if it is temporary.”

The alternative to inserting a catheter through the urethra’s sensitive tissue is to place a suprapubic tube in the lower abdomen. “This procedure is not new, but it is under-utilized,” Dr. Brecht explains. “It is typically performed on an outpatient basis and is far more comfortable than a catheter through the urethra.”

The small tube is hidden and can be uncapped by the patient so that urine can be drained. The suprapubic tube typically remains in place for a few weeks, although it can remain there permanently. “Patients prefer it to a catheter, which condemns them to an awkward, asocial life,” says Dr. Brecht.

Gynecologic Surgery

Colleen Feltmate, MD, a gynecologic oncology surgeon from Brigham and Women’s, works with local gynecologists to keep much minimally invasive surgery at Emerson. “These include cases of precancerous endometrial hyperplasia, which we tend to see in women in their later premenopausal or early postmenopausal years,” she explains. “With the increase in women who are significantly overweight, we are seeing more of this. Their extra weight leads to excess estrogen, which contributes to abnormal menstrual cycles and overgrowth of the uterine lining.” Patients typically opt for a hysterectomy. In 30-35 percent of cases where endometrial hyperplasia is diagnosed, cancer is detected.

“We also operate on women with cervical precancerous states,” Dr. Feltmate adds. “Sometimes removing a cone-shaped section from the cervix is adequate to perform a biopsy. There is a good, symbiotic relationship where the gynecologist, patient and I discuss whether or not surgery is required and if it can be performed at Emerson. Even if the surgery is too complex to be performed at Emerson, the follow-up is always at Emerson, which patients appreciate.”