Big Results Through Small Incisions
Retired Episcopal Priest Is 1st Patient Treated in New Hybrid O.R.
For several years, Vincent Liddle, 79, had been living with an abnormal ballooning of his abdominal aorta – the main artery that supplies blood to the lower part of the body. Doctors had been keeping a close eye on the weakened blood vessel with periodic ultrasound scans. He had no symptoms and no restrictions. He had been spending his days in semi-retirement, serving part time as an Episcopal priest at St. Matthew’s Church in Maple Glen.
In October 2012, a routine ultrasound showed that Vincent’s abdominal aortic aneurysm (AAA) had grown. At 5.3 centimeters, the bulging blood vessel could easily burst, which could result in massive internal bleeding. “With an abdominal aortic aneurysm, we wait to intervene until the risk of rupture outweighs the risk of surgery,” says Theodore Sullivan, MD, director, Vascular Surgical Services. Vincent’s artery had reached that point. Remarkably, Dr. Sullivan would not need to make a large incision in Vincent’s abdomen to fix the aneurysm. Instead, he’d repair it by traveling inside Vincent’s aorta, guided by advanced imaging technology.
A decade ago, the only surgical option for Vincent would have been an open operation, requiring a sizeable incision in the abdomen. “Thanks to advances in medical techniques and technology, we can now offer a minimally invasive procedure to nearly 80 percent of those who require AAA repair,” says Dr. Sullivan. These procedures result in less physical stress and postoperative pain and have a significantly shorter recovery period than traditional open surgery.
Vincent was the first patient at Abington Memorial Hospital to benefit from surgery in the hospital’s new $3.5 million hybrid operating room. Larger than a traditional operating room, the hybrid O.R. is equipped with highly developed fluoroscopy (continuous real-time X-ray) equipment used in combination with 3-D high-definition video technology. “The image quality in the hybrid O.R. is absolutely stellar,” says Dr. Sullivan. Although X-ray-guided procedures require minimal exposure to radiation, the sophisticated equipment in the hybrid O.R. results in even less exposure during procedures – an advantage for both the patient and the medical team.
The hybrid O.R. combines treatments traditionally offered only in the interventional radiology suite or cardiac catheterization laboratory with those traditionally offered only in the operating room. AMH’s hybrid O.R., one of only a handful in the region, enables specialists to perform catheter-based, minimally invasive work with the capacity to perform full surgical interventions, if necessary, in one setting. Vascular surgeons, cardiothoracic surgeons, interventional cardiologists, interventional radiologists, neurosurgeons and/or neurointerventionalists can work collaboratively in one room.
Prior to the establishment of Abington’s hybrid O.R., many procedures had to be staged, first in the cardiac catheterization or neurovascular laboratories, with surgery scheduled at a later date. The hybrid O.R. combines the best of both worlds, allowing for a single hospital stay and recovery for the patient.
To repair Vincent’s AAA, Dr. Sullivan performed an endovascular aortic stent graft. Through small incisions on each side of the groin, he used live X-ray technology to guide catheters (thin tubes) through blood vessels to the site of the aneurysm. Through the catheter, he threaded a stent – a tube comprised of fabric reinforced by metal mesh – and attached it to the healthy parts of the artery above and below the aneurysm. Once the graft was in place, blood flowed through it, removing pressure from the surrounding aneurysm. “Vincent’s case was almost textbook as far as endovascular AAA repair goes,” says Dr. Sullivan. “It was a planned procedure with a great outcome.”
Although Vincent’s was a relatively uncomplicated situation, the hybrid O.R. enables experts at AMH to treat the highly complex cases they previously would have had to refer to another center. Frequently, such cases are life-threatening.
Vincent was thrilled with the results of his surgery. “I had very little pain afterward,” he says. “I spent just one night in the hospital and about a week taking it easy at home.” He has resumed his retirement lifestyle, assisting at St. Matthew’s Church. In addition, he intends to spend some time puttering in the garden, visiting with grandchildren and taking walks with wife Rosemary and their two dogs, who rule the household.