1. Samuel Vincent G. Yrastorza, MD, FPUA
ADVANCES IN SURGERY
Samuel Vincent G. Yrastorza, MD, FPUA

2. DIAGNOSTICS Symptomatic disease
Has grown leaps and bounds for the past years
Symptomatic disease
- history and PE still accounts for 80-90% in clinching the diagnosis
Asymptomatic diseases
- screening procedures detect early diseases
- e.g. colonoscopy for colon cancer

3. Colonoscopy, Abdominal CT scan
DIAGNOSTIC ADVANCES
Before
Signs and Symptoms + PE
Abdominal pain, Diarrhea
PE = abdominal mass
Diagnostic Exam/Imaging
Stool exam
Colonoscopy, Abdominal CT scan
Diagnosis
Colonic Cancer

4. Without any signs or symptoms of disease
DIAGNOSTIC ADVANCES
Presently
Reaching 40 y/o
Without any signs or symptoms of disease
Screening Colonoscopy
Small colonic mass noted and biopsy done
Colonic Cancer

5. DIAGNOSTIC ADVANCES CT Scan - Has become more sensitive and specific
Diagnostic modality of choice for a majority of surgical cases with the advent of
3D reconstruction
CT angiography

6. DIAGNOSTIC ADVANCES
CT Scan
prototype
EMI CT scan
256 slice CT scan

7. IMAGING
CT before
256 slice with 3D reconstruction
COLON

8. IMAGING
Colonoscopy
256 slice with 3D reconstruction

9. IMAGING
CT before
128 slice with 3D reconstruction
KIDNEYS

10. IMAGING
Conventional angiogram
CT angiogram

11. Radiotherapy Brachytherapy
- Greek brachy meaning “short”
- radioactive source placed inside or next to the area of treatment
- not just for adjunctive therapy or pallation
- as first line treatment for various forms of cancer
- commonly used for prostate cancer, cervical cancer , head and neck cancer
- radioactive sources
- strontium plaque
- iridium wires
- iodine 125 seeds

12. PROSTATE BRACHYTHERAPY

13. PROSTATE BRACHYTHERAPY

14. PROSTATE BRACHYTHERAPY
- for early and localized cancer
- not for locally advanced or metastatic prostate cancer
- comparable result to radical prostatectomy
- out patient procedure
- lesser complications than radical prostatectomy
- uses iodine 125 seeds

15. LOCALIZED PROSTATE CA TREATMENT
brachytherapy
Radical prostatectomy

16. Probes/needles directed at organ or tissue
CRYOTHERAPY
Probes/needles directed at organ or tissue
Freezing ---- thawing---- freezing
cellular disruption
cell death

17. CRYOTHERAPY - benign and malignant skin conditions
Used for
- benign and malignant skin conditions
- early and localized cancers
- liver
- prostate
- hemorrhoids

18. CRYOTHERAPY - benign and malignant skin conditions
Used for
- benign and malignant skin conditions
- early and localized cancers
- liver
- prostate (widespread use)
- hemorrhoids

19. CRYOTHERAPY
ice balls

20. RADIOFREQUENCY ABLATION
RFA probe (needle) placed inside the tumor
(guided by CT scan or ultrasound or through open procedures)
Radiofrequency waves passed through probe into tumor
increased in temperature within tumor
tumor necrosis

21. RADIOFREQUENCY ABLATION
Indications
- tumors of the lung, liver, bone
- used for primary and metastatic tumors
- recurrent atrial fibrillation and supraventricular tachycardia
- varicose veins

22. RADIOFREQUENCY ABLATION
RFA probe (needle)
RFA generator

23. RADIOFREQUENCY ABLATION

24. RADIOFREQUENCY ABLATION
Percutaneous approach
Laparoscopic approach
Open approach

25. HIGH INTENSITY FOCUS ULTRASOUND (HIFU)
directed at tissue/tumor (by ultrasound or MRI)
increase temperature at target tissue/tumor
tissue/tumor destruction

26. HIGH INTENSITY FOCUS ULTRASOUND (HIFU)
used for:
- uterine fibroids
- solid tumor of the brain, bone, breast, liver, pancreas, rectum, kidney, testes, prostate
- earliest and widest use = for prostate cancer
- atrial fibrillation, arrhythmia

27. HIGH INTENSITY FOCUS ULTRASOUND (HIFU)

28. SURGICAL PROCEDURES - Trend toward less invasive procedures NOW
The “old way”
NOW

29. LAPAROSCOPIC SURGERY Minimally invasive surgery Minimal access surgery
Key hole surgery
Pinhole surgery
Band-aid surgery
*** part of a broader field of ENDOSCOPY

30. LAPAROSCOPIC SURGERY
Access

31. LAPAROSCOPIC SURGERY Used for: - diagnostic - cancer surgery
- donor organ harvest ( donor nephrectomy)
- vascular surgeries
- practically any abdominal surgery

32. LAPAROSCOPIC SURGERY Advantages - smaller incisions (smaller scars)
- fast recovery (short hospital stay)
- better visualization of abdminal structures

33. LAPAROSCOPIC SURGERY Disadvantages - more expensive
- requires expertise
- steep learning curve
- longer operating time (gap is slowly closing with that of open surgery)

34. ARTHROSCOPIC SURGERY Cystoscopic surgery of the joints
Similar advantages and disadvantages as laparoscopy
arthroscopic
Open Knee
surgery

35. THORACOSCOPIC SURGERY
Cystoscopic surgery of the THORAX
Similar advantages and disadvantages as laparoscopy
Instruments basically the same
Open thoracic surgery
thoracoscopic

36. Others
Cranioscopy???
Not enough space

37. Microlaparoscopy 3mm port instead of the usual 5 and 10 mm ports
Smaller instruments
Lesser pain and scar

38. ROBOTIC SURGERY

39. ROBOTIC SURGERY

40. ROBOTIC SURGERY

41. ROBOTIC SURGERY

42. ROBOTIC SURGERY

43. Telementoring Teaching/mentoring through the internet
“out of school students”
Open universities

44. Telementoring

45. Telementoring
Surgical training though internet or other forms of telecommunications

46. Telesurgery

47. Stem Cell Therapy Use of stem cells to treat certain diseases
To create new tissues/organs to replace/augment the existing ones

48. Stem Cell Therapy Use of stem cells to treat certain diseases
To create new tissues/organs to replace/augment the existing ones
New pancreatic cells transplanted into patient
DM type 1

49. Stem Cell Therapy Stem cells
- unspecialized cells capable of renewing themselves through cell division
- can be induced to become tissue or organ specific cells
- in gut and bone marrow
= stem cells regularly divide to repair and replace worn out or damages tissues
- pancreas and heart
= stem cells divide only under special
conditions

50. Stem Cell Therapy Categories 1) Non embryonic
- somatic or adult stem cell
2) Embryonic
- use of human embryo

51. Stem Cell Therapy Non embryonic e.g. Bone Marrow transplant
- for luekemia
- replacing the old marrow with new Bone Marrow
- new marrow will produce new and normal blood cells
(leukocytes, macrophages etc)

52. Stem Cell Therapy
Embryonic

53. Stem Cell Therapy The Promise of stem cells
1) Understanding the development of specialized cells and eventually the evolution of diseases
2) Possibility of renewable source of replacement cells and tissues to treat diseases

54. What Else?
Penile Transplant???!!

55. END