Laparoscopy and General Surgery

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Dr. Larry Demco: "I’m at the Society of Laparoendoscopic Surgeons 4^th Symposium on Diagnostic and New Techniques in Laparoscopy, and I’d like to now interview Dr. Peter Geis. Peter Geis is one of the pioneers in the surgical field as a general surgeon in laparoscopy, and he’s from Baltimore, Maryland. Peter, in the field of general surgery, what advances do you see for the female patient with regard to the new laparoscopic approach in women’s healthcare?"

Dr. Peter Geis: "I think that it’s very clear, Larry, that many patients, both male and female, live with a certain amount of abdominal pain, often following inflammatory disease processes, trauma, prior operative procedures, or a combination of those. The things that are important, number one, is that we physicians, surgeons, and gynecologists start recognizing that there are solutions to these pains that people have lived with and just assumed there was no solution. Number two, we now have the technology to enter the abdominal cavity, the upper abdomen and the pelvis. Collaboratively, general surgeons and gynecologists can now do this in order to assess and diagnose the pain, as well as the cause of the pain, so that we can find a solution.

The ability to use less traumatic and less physically insulting instrumentation on a patient who’s awake in the operating room allows us to have the patient actually participate, as you know better than most because you’ve been key in the development of this field. My opinion is that we will find a very succinct combination of events that will involve participation of the patient in an awake state. This will help us solve many problems, sometimes collaboratively, between gynecologists and general surgeons because the diseases often overlap, sometimes by the gynecologists, and sometimes by the general surgeons. But the main thing that is allowing this to happen is not only the technology, but the interaction that’s occurring between specialties these days."

Dr. Larry Demco: "One of the common complaints as a source of pain is adhesions, and it’s always been a struggle for both patients and surgeons. Can you give us a little background on what the general approach to adhesions is? My next question is about the new developments in adhesion diagnosis and treatment."

Dr. Peter Geis: "Certainly. I think that it’s clear to the surgical community that more than any other specialists, gynecologists over the last forty years or so have always been more attentive to the possibility that adhesions may cause significant pain for patients. General surgeons and colon-rectal surgeons have historically been under the impression that adhesions don’t cause pain unless they cause the bowel to twist, for example. That’s usually associated with a partial small bowel obstruction or a complete small bowel obstruction, or some process involving ischemia because of the twisting of the tissue. Those events are usually serious, abrupt, catastrophic, and require surgery immediately.

For the most part, I think the last decade has allowed general surgeons, colon-rectal surgeons, and others who enter the abdomen to catch up and accept the possibility that pain can not only be significant and imposing on one's lifestyle, but can also be chronic and be caused by adhesions. That's the first step in our understanding, which we have learned from obstetricians and gynecologists. The second step is that we now can do something about the adhesions. Historically, many of us would operate on a patient if we saw dense adhesions that seemed to twist the bowel because we would think that might be the cause of the problem. But if we saw filmy adhesions or adhesions that didn’t seem to twist any of the organs in the abdomen, we would generally think they were non-contributory and not important."

Dr. Larry Demco: "Thank you, Dr. Geis."