Surgery - Preparation and Recovery
Novel and Emerging Strategies
Modern surgeries are faster, more precise, and more effective than ever before, but new techniques are being developed that will make surgery even less invasive. One approach is to use the body's natural openings to access internal parts of the body. For instance, surgeons are exploring ways to operate on the thyroid through a patients mouth (Sivakumar 2018) or the gallbladder through a patient's vagina (Benhidjeb 2018).
A second approach to making surgery less invasive is decreasing the size of the incision or number of incisions. Researchers are developing robots that surgeons can control to access the affected area without needing a large incision (Isaac-Lowry 2017). Some laparoscopic surgeries that normally used to require more than one incision can now be performed with only one incision (Binet 2017).
In addition to making surgery less invasive, robots may also minimize human errors and make surgery more precise (Peters 2018). Although traditional robots are made from rigid materials, researchers are finding ways to use soft materials to improve dexterity (Diodato 2018). Some researchers are even developing robots that can perform surgical tasks on their own—the surgeon only preprograms the surgery and supervises the procedure. One of these robots, called smart tissue autonomous robot or STAR, has been shown to make fast and precise incisions, suture incisions consistently, and even remove tumors (Opferman 2017; Shademan 2016). Telesurgery has also been made possible by robots and modern high-speed data services. In telesurgery, patients can be operated on by a surgeon theoretically anywhere in the world. The surgeon operates a surgical robot from a control suite connected to a high-speed data feed from the surgical robot, allowing the surgeon to perform detailed, carefully executed surgery from a distance.
Advances in artificial materials and body parts will also dramatically improve surgical options and outcomes. Artificial heart valves have been an option for decades for many patients needing heart valve replacement (AHA 2016; Dasi 2009), and artificial joints are used for knee or hip replacement (Carr 2012). Now, surgeons are exploring ways to use three-dimensional (3-D) printed bones and other tissues to create new parts for surgery (Di Bella 2018; Yang 2018; McGilvray 2018). 3-D printed models of target organs or tissues can also be made for each patient to help a surgeon optimize the surgical plan ahead of time or design custom prosthetics (Sun 2018; Li 2018).
Surgery and Sepsis
All surgeries run the risk of exposing patients to infections. One of the most feared consequences of surgery-associated infection is sepsis. Sepsis occurs when the immune response to infection leads to catastrophic systemic inflammation, often culminating in organ failure and death (Sepsis Alliance 2017).
Although sepsis can arise from many kinds of wounds or infections, about 30% of cases arise in surgical patients. This means that patients scheduled to undergo surgery should be aware of the risks of sepsis, and should also know about intriguing new evidence that suggests a combination of intravenous vitamin C, thiamine (vitamin B1), and hydrocortisone may offer improved outcomes in sepsis treatment.
In a retrospective study published in 2017, Dr. Paul Marik and his team at Eastern Virginia Medical School reported remarkable success in treating sepsis with IV vitamin C, thiamine, and hydrocortisone (Marik 2017). The study consisted of two groups, with 47 sepsis patients enrolled consecutively in each group over sequential seven-month periods. The treatment group received the IV vitamin C, thiamine, and hydrocortisone combination, and the control group received standard care.
In the control group, 19 of the 47 patients died in the hospital. In contrast, only 4 of the 47 patients in the treatment group died, representing an astonishing 87% relative reduction in the risk of death from sepsis.
Several large randomized clinical trials are recruiting at the time of this writing (ie, May 2018) to verify these effects in rigorous fashion. If these trials prove as successful as Dr. Marik's early efforts, the result could be a revolution in sepsis treatment that saves millions of lives.