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The Achievements of Surgery without a Scalpel

by Gilles Rousset
**Highly skilled surgeons are increasingly practising non-invasive surgery, without using scalpels and without opening up the body, for the greater benefit of patients.***
THE surgeon hardly casts a glance at the sleeping body lying on-his operating table. His eyes are glued to the video screen giving him a detailed picture of the patient's insides. He follows the path of the tiny syringe which, after entering via the femur artery, will reach the heart in order to dissolve a bloo'd-clot. When the patient wakes up. the ohly sign that he will see, of the operation, " will be a small red spot, about the size of a lentil, half-wav up his •high.
Foe a long time. French surgeons have been pioneers in this area. Already, in Paris, in 1940. Dr Raoul Palmer was the first person to insert a piece of equipment bearing a ^source of light (an endoscope) inside the abdomen of d patient. via the navel. It was the beginning of coelioscopy. It was no longer necessary to open up people's abdomens to see what was happening inside.
As early as 1973. in Clermont-Ferrand. Professor Bruhat operated on an extra-uterine pregnancy without opening up the patient. Ten years after this world first, his team was to develop an endoscope bearing a laser, able to destroy internal lesions by vaporization.
Endoscopic surgery developed further with the invention. about 20 years ago. of op tic fibres diffusing a cold light. It thus became possible to build a kind of miniature torch which, after* being inserted into the body via the natural orifices or through a tiny incision, enabled a patient's insides to be explored.
Catheters, which are tubes that are sometimes thinner than a hair, carry extremely miniaturized Instruments on a
real expedition through Ihe vessels to the part of the body that is to be treated. It can bear probes, scissors, brushes, files, planes, suction devices, lasers, etc.. They thread their way through the organs and hunt around in the nooks and crannies that are very difficult to reach, perforating, cutting, scraping, sewing, pulverising,
etc.
Today, 210 kinds of surgical operations can be carried out by endoscopy, whereas 20 years ago. only a single operation was performed In this way (in the articulation of the knee).
Through the skin
Heart and brain operations
are carried out without opening the thorax and without cutting windows In the skull. In gynecology", a surgeon at La Pttie-Salpetrtere hospital In Paris, explains, "in more than 80% of cases, the traditional scalpel can be left In Its drawer".
The digestive system is operated on without opening up
the body, for instance In the case of obstruction of the bowels. Excision of the vesicles is practised-. Slipped disks are treated by destroying the part of the disk trapping the sciatic nerve. ’
In the area of blood circulation. where, in the past, any operation was reputedly impossible. surgeons now insert a catheter bearing a tiny balloon, into the blocked artery. When the balloon is inflated. at stretches the Inside walls of the artery and opens up the way for the blood to circulate again. Hence, one can see patients in a coma who suddenly regain consciousness.
The results offered by endoscopic surgery are at least as good as those obtained using traditional methods. The advantages are .tremendous, according to a professor at the Paris Faculty of Medicine. It reduces the trauma in a patient. helps him to recover more quickly and avoids scarring. The surgeon operates in more comfortable conditions. For the community, there Is an important advantage In that the operations cost less and the stay In hospital is shorter.
But surgeons are thinking of doing better still, by extending the applications of the lithotriptor. that machine which, using shock waves, reduces kidney stones and gall stones to dust. This means operating at a distance without touching the human body: the surgeons dream. Using the same principle, could It not be possible to succeed in ellmi nating or re-sorbing tumours, blood-clots, fatty plagues in blood arteries, faulty appendixes. etc? With the dawning of the 21st century, a new revolution Is appearing in operating theatres
— L'Actuallile en France