Minimally invasive technology and techniques are transforming the way many doctors perform surgery. In the past, open surgery was the only option available when doctors needed to see inside a patient's body or remove or repair organs or tissue. And patients who have conventional open surgery typically face large incisions, significant hospital stays, lengthy recoveries and the risk of complications.

That's no longer the case. Today, surgeons at Manatee Memorial Hospital make small incisions or "ports" and perform minimally invasive procedures whenever possible. These procedures can accomplish the same results as traditional surgery but can be much less traumatic to patients.

"We use minimally invasive techniques so patients can get back to their normal lives as quickly as possible," says Jose A. Erbella, MD, a board-certified general and vascular surgeon at Manatee Memorial Hospital. "We can use a variety of tools, including small cameras, thin flexible scopes, specially designed devices and tiny surgical instruments, to reach the surgical site and perform the surgery patients need."

A Full Range of Minimally Invasive Procedures
The experienced surgeons at Manatee Memorial Hospital offer a full range of minimally invasive procedures that can address problems in nearly every part of the body. Here are some of the most common procedures they perform:

• Abdominal surgery -- Traditional surgery to remove the gallbladder or appendix involves a large incision in the abdomen. Surgeons then open the body so they can see, dissect and remove the diseased organ. Now, doctors can make small incisions in the belly button and abdomen and use a tiny camera and instruments to view the surgical site and remove the organ through the belly button.
• Colorectal surgery -- Many patients with colon diseases, including polyps, inflammatory bowel disease and diverticulitis, can avoid the large 8- to 10-inch incisions associated with open surgery by undergoing minimally invasive procedures. Doctors can use innovative techniques and tools to remove polyps or diseased portions of the colon.
• Hemorrhoid surgery -- Some patients with hemorrhoids try to live with their discomfort because conventional surgery can be very painful. "Traditional surgery can affect sensitive nerve endings because it involves cutting deep into the anal canal, below what we call the pain line, to remove the hemorrhoids," says Dr. Erbella. "Patients are much more comfortable when we perform a new, less invasive procedure, called the Procedure for Prolapse and Hemorrhoids (PPH)." During PPH, doctors cut away some of the excess tissue that causes patients' symptoms and use a special stapling device to lift and reposition tissue in the anal canal. PPH reduces blood flow to the hemorrhoids. Over a period of weeks, the hemorrhoids shrink and become less painful. As an added benefit, doctors can often remove all of a patient's hemorrhoids during one PPH procedure. Surgeons can only remove a few hemorrhoids during traditional surgery so patients often need multiple surgeries.
• Hernia surgery -- New minimally invasive techniques are improving the outlook for patients with abdominal or inguinal hernias. These hernias occur when the internal organs protrude through weaknesses in the abdominal wall or the groin area. Historically, patients with hernias often had open surgery so doctors could find and close the defect and reposition the organs. Patients who had bilateral hernias, or hernias on both sides of the body, usually needed two surgeries. Now, however, doctors can make small incisions in the abdomen, insert cameras into the openings, locate the hernia and use a mesh device to reinforce the weakened area. Doctors can often correct bilateral hernias during one minimally invasive procedure.
• Adrenal surgery -- In the past, surgeons made incisions in the abdomen or back to reach the adrenal glands, which are located near the kidneys, and removed benign tumors or tumors related to Cushing's syndrome. Now, doctors at Manatee Memorial Hospital can use minimally invasive techniques and tools to remove these tumors.
• Parathyroid surgery -- Doctors can perform a less invasive two-step procedure to remove parathyroid glands or tumors. During these procedures, patients are given a radioactive isotope dye, which is absorbed by the abnormal parathyroid gland. Surgeons then use a gamma probe to locate and remove the diseased gland. Doctors can make smaller incisions along the neckline when they perform minimally invasive parathyroid surgery. Traditional surgery requires a longer incision because doctors have to view all four parathyroid glands to visually identify the abnormal gland.

	Jose A. Erbella, MD, left, and Gary M. Bunch, MD, perform a range of minimally invasive procedures.

Patients Feel the Benefits
Doctors can't perform every surgery using minimally invasive techniques, and some patients aren't candidates for these procedures. But patients who do undergo minimally invasive procedures usually experience a variety of benefits when compared with those who have open surgery.

"Since we make smaller incisions, patients often have less pain and scarring," says Gary M. Bunch, MD, a board-certified general and vascular surgeon at Manatee Memorial Hospital. "They spend less time in the hospital, recover more quickly and have fewer complications. We're also able to use these procedures to treat some older and sicker patients who may be too frail for open surgery. Patients who need surgery should ask their doctors if there are any minimally invasive alternatives."

For more information about the minimally invasive procedures available at Manatee Memorial Hospital, please call 941-744-2700 or visit www.bradentonsurgery.com.

New, More Precise Thyroid Surgery
Some patients who undergo thyroid surgery at Manatee Memorial Hospital are benefiting from an innovative device that allows doctors to make a smaller incision in the neck and can reduce complications that sometimes occur during conventional surgery.

Patients may need surgery when their thyroid gland, which secretes hormones that help regulate our metabolism, becomes enlarged or develops tumors. Since the thyroid gland is located in the neck near the vocal cords, damage to the laryngeal nerves is a common complication of thyroid surgery. This damage can cause hoarseness and breathing difficulties.

Surgeons at Manatee Memorial Hospital are using new technology that makes thyroid surgery safer for patients. They're able to make a smaller incision in the neck and use a special nerve monitor that helps them locate and avoid the laryngeal nerves.

Jose A. Erbella, MD Bradenton Surgical Group 250 2nd St. East, Suite 3A Bradenton, FL 34208 941-744-2700

Gary M. Bunch, MD Bradenton Surgical Group 250 2nd St. East, Suite 3A Bradenton, FL 34208 941-744-2700

206 Second Street East, Bradenton, FL 34208 941-746-5111 FAX: 941-745-6862