In Pursuit of Precision - University of Alabama at Birmingham

Cover Story
chronic sinusitis, tumors, and spinal fluid leaks. Sillers began
using computer-based surgery for chronic rhinosinusitis in 1996.
Since then, computer-assisted techniques have expanded to
other areas, including surgery for skull-based tumors.
In an article written for the winter 2002 issue of UAB Insight,
Sillers explains that the complex anatomy of the anterior skull base
makes tumors difficult to remove. A computerized surgical navigation
system helps correlate images seen endoscopically with preoperative
CT scans. With improved technical precision, the surgeon can remove
tumors more completely and treat larger skull tumors.
“Although this hasn’t been proven statistically, I believe computer-assisted
surgery has increased safety by reinforcing surgical
landmarks and reduced overall complications for patients. It’s
also increased the surgeon’s ability to do a complete job of tumor
removal, or removal of disease in chronic sinusitis or nasal
polyps,” Sillers says. “More applications in nasal, skull base, and
ear surgery lie ahead.”
PLASTIC SURGERY ON THE NONCUTTING EDGE
Jorge de la Torre, M.D., gives credit to plastic surgery department
director Luiz Vasconez, M.D., for initiating endoscopic
approaches to plastic surgery at UAB.
“Plastic surgery was one of the last specialties to take advantage
of these techniques because of where in the body we work,”
says de la Torre, assistant professor of plastic surgery. “Surgeons
working in the abdomen have a nice cavity where they can look
in and see what they’re doing. We had to customize endoscopic
needs for plastic surgery, developing some ancillary equipment
to dilate and suspend tissue so we can create a cavity in which we
can see and work.”
De la Torre says he is now using endoscopes for a variety of
procedures, including forehead lifts and breast augmentations.
He also uses endoscopic techniques to harvest tissue in the
abdomen for reconstructive surgery.
“The use of the endoscope not only allows us to make smaller
incisions, but it also enables us to magnify the structures we’re
looking at. In many cases, we can visualize these structures better
than we could with a large incision,” de la Torre says.
“There’s more precise control, and less bruising and swelling
afterward. With endoscopic surgery, we also avoid some undesirable
side effects of large incisions, such as scar location and
impact on hair growth.”
De la Torre believes the trend will accelerate. He and other surgeons
using CAMI techniques are excited about the potential of
the new AIMS center for training residents and practicing surgeons,
and for developing new equipment and techniques.
As orthopedic surgeon Jorge Alonso says, “This approach to
surgery is like surfing. You have to get in the wave early to stay on
top. We got in the wave very early. And we can stay on top.”
New Institute Will Support Training, Research
Although numerous UAB surgeons
have used computer-assisted, minimally
invasive techniques and equipment
for several years, they’ve done
so independently or within surgical
departments. The newly established
Alabama Institute for Minimally
Invasive Surgery (AIMS) will soon
change that situation. AIMS has two
major goals: to provide training
opportunities spanning every specialty
in surgery, and to support research
and innovation in new areas of minimally
invasive surgery.
“This is a comprehensive effort,
spurred on by the vision of Dr. Kirby
Bland, chair of the Department of
Surgery,” says Ronald Clements,
M.D., AIMS director. “Our first objective
is to have a comprehensive training
program for the surgical residents,
so when they leave here, they can
perform minimally invasive surgery
safely and effectively. Another goal is
to conduct continuing education programs
for practicing surgeons who
haven’t received training in current
procedures.”
In addition to clinical training,
AIMS will have a conference facility
and telecommunications center in
Volker Hall. “The telecommunications
center will connect University
Hospital, the Kirklin Clinic, Children’s
Hospital, and sites anywhere else in
the world,” Clements says. “For
instance, if I’m conducting a teaching
conference on laparoscopic gastric
bypass surgery, surgeons in the
conference room can see the live
operation, and we can talk back and
forth as the surgery is performed.”
Clements is one of three surgeons
in the Department of Surgery
who have received postresidency
training in laparoscopic surgery.
The others are Gregg Shore, M.D.,
and Mary Hawn, M.D. Hawn, assistant
professor of surgery, is AIMS
codirector for training.
“The residents will have simulation
training initially,” Hawn says.
“They’ll practice suturing in a box
where they’ll use a reflective mirror
that re-creates the two dimensional
feeling you have when doing
laparoscopy. You’re doing a threedimensional
operation with a twodimensional
image, so you must
work on other ways to determine
depth perception and tissue
strength. We’re also looking at
using a virtual reality trainer. But
these are still in the early stages of
development, and it will mostly be a
research tool to see if we can correlate
performance on the trainer
with resident performance.”
Clements has recruited AIMS
representatives from every surgical
specialty. One team member,
Sharmila Makhija, M.D., assistant
professor of gynecologic oncology,
says that while laparoscopy has
been a longtime practice in removal
of ovaries, it’s still a new technique
for surgical staging, which requires
sampling lymph nodes. “Minimally
invasive surgery is pretty new to our
field, but we look forward to being
part of the team,” she says.
Clements and Hawn envision
AIMS as a launching pad, both
for basic research that applies to
clinical situations, and for testing
new techniques and equipment.
“Manufacturers want surgeons to
try out new software and equipment,”
Clements says. “We expect
to be part of that research effort.”
The objective of AIMS will be to
expand surgical skills—not alter them.
“If our technology fails, you have to
have a backup or convert to the traditional
open operation,” Clements
says. “You have to have a safety net.”
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