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Belly-button surgeries in 'evolution'

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Monday, Nov. 17, 2008

Dr. Antonio J. Ripepi jokes that sometime in the future, patients will get gallbladder surgery at the drive-through.

"Who knows, maybe that's just around the corner," said Ripepi, a surgeon at St. Clair Hospital in Mt. Lebanon.

For now, Ripepi is content doing the next best thing: Removing diseased gallbladders through a tiny incision in the belly button. It is the latest, most talked-about surgical technique in medicine these days, following the now common three-incision surgery.

It is beginning to make its way around the country, with surgeons at St. Clair, Allegheny General Hospital and Magee-Womens Hospital of UPMC just starting to do the surgeries in the past two weeks.

"It's not the future, it's the present," said Ripepi, who first performed the surgery Oct. 20 at St. Clair. "These are the expanding frontiers of medicine."

Surgeons say it is an all-around better, safer operation than its predecessors. The lack of incisions in the abdomen sharply cuts the potential for infection.

The incision is virtually scarless, and patients typically spend less time in the hospital, often being discharged on the same day of the procedure.

"There's undeniably better results when patients spend less time in the hospital and can get back to work faster," said Dr. Joseph Colella, an Allegheny General surgeon who started doing one-incision gallbladder surgeries last week.

Sara Cannon can attest to the surgery's advantages. She had it late last month at St. Clair Hospital after what she initially thought was a case of appendicitis. Her procedure is believed to be the first in Western Pennsylvania.

"When the doctor told me about the surgery, I wasn't sure what to think about it," said Cannon, 21, of Beechview.

A few days later, she couldn't even tell she had the surgery.

"I feel fantastic and so much better than I did before," said Cannon, who works as a waitress and attends Duquesne University.

The new technique could help the thousands of people with gallbladder disease, which involves inflammation, infections, stones or obstruction of the gallbladder.

During the procedure, surgeons make an incision of about 15 millimeters, through which they introduce multiple devices including a tiny camera that transmits images of the gallbladder to monitors in the operating room.

While the technique is being used mostly for gallbladder removal, some surgeons expect to use for weight-reduction surgeries such as gastric bypass.

"It's an evolution," said Dr. Anita Courcoulas, director of Minimally Invasive Bariatric and General Surgery at Magee. "We're training for that right now."

In the future, the one-incision procedure could be used to repair hernias and treat some forms of cancer. It also might be used to remove kidneys and perform breast biopsies.

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