2010 Medical Breakthroughs
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2010 Medical Breakthroughs 

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November 2010

Potomac Hospital Medical Breakthrough

Elevate® For Treating Pelvic Organ Prolapse Minimally Invasive Surgery Option

Pelvic organ prolapse is a common condition affecting one out of two women over age 45. It occurs when pelvic structures, like the bladder or rectum, bulge or protrude into the vaginal wall.

Treatment for pelvic organ prolapse can include non-surgical and surgical options, depending on the type of prolapse, the severity of the condition, and a woman’s general health, age and desire to have children.

With the patient under general anesthesia, surgeons make a small vaginal incision and insert a soft synthetic or biologic mesh in the pelvic area where the repair is needed. The mesh is then secured in the body to strengthen and support structures around the prolapsed area, returning them to a more normal position.

Because it is performed vaginally, there are no external incisions or scars and trauma to surrounding tissue is minimized. Elevate® surgery usually involves less pain than open, abdominal surgical options and the recovery period is shorter.

Elevate® surgery usually requires an overnight hospital stay, but in some cases it can be performed on an outpatient basis. Surgery to address incontinence concerns can be done at the same time.

Your surgeon can determine if Elevate® would be best for you. For information on board-certified general and fellowship-trained urologists call Sentara Potomac Hospital Health Connection at

- Common symptoms of pelvic organ prolapse include feelings of pelvic pressure, bulging, urinary or fecal incontinence, and pelvic pain.

- Muscles and ligaments in the pelvic area that have been weakened or damaged, from childbirth, previous surgeries, obesity, age, repetitive straining and other factors can cause pelvic prolapse.

- Many women have relief of symptoms immediately or shortly after the Elevate® procedure and are able to return to work after one-to-two weeks.

Biologic Tissue Used to Repair Rectovaginal Fistulas

The operating room at Sentara Virginia Beach General Hospital was the first site in Virginia where a rectovaginal fistula was repaired by a colorectal surgeon using an innovative technique involving a biologic tissue mesh.

Any condition with the word “rectal” in it makes for a difficult conversation. But for women suffering with a rectovaginal fistula, it’s even more challenging to find a procedure for the repair and healing of this medical issue.

A rectovaginal fistula is defined by an abnormal opening between the rectum and the vagina. The resulting passage of gas and/or stool from the rectum into the vagina causes a distressing vaginal leakage which can result in frequent urinary tract infections. Often due to some trauma to the area, a rectovaginal fistula is in a difficult place for proper healing.
While some fistulas heal on their own, most rectovaginal fistulas do require surgery.
Sometimes traditional surgery for this type of fistula is not successful.

The innovative BioLIFT procedure allows the surgeon to close the opening (fistula track) between the rectum and vagina with an overlapping section of biologic mesh to provide stability and promote cell in growth and healing of the fistula. Unlike synthetic mesh, the biologic mesh is composed of living tissue which is resistant to infection and is therefore safer to use in this area of the body.

Rectovaginal fistulas are rare. Talk with your physician about any concerns you may be experiencing.

Some causes of a rectovaginal fistula:
-Injury during childbirth
-Crohn’s Disease
-Cancer or radiation treatments
-Surgery complication
-Unknown (idiopathic)

For a board-certified colorectal surgeon, call 1-800-SENTARA or visit sentara.com/smg.

September 2010

TransOral Robotic Surgery (TORS)

Sentara Norfolk General Hospital and an Eastern Virginia Medical School head and neck surgeon are the first in the state to offer the TORS procedure. The surgeon uses the advanced technology of the da Vinci® robot to enter the body through the mouth to remove cancerous, and non-cancerous, lesions of the mouth, throat or voice box. Patients benefit by avoiding a large surgical incision on the face and neck.

It’s easy to think about your mouth as a natural opening for feeding your body. But with the new TransOral Robotic Surgery (TORS), the mouth also serves as a natural opening for removing cancerous and selected non-cancerous lesions. That’s good news for the estimated 49,000 Americans1 who will be diagnosed this year with cancer of the tongue, voice box, mouth and throat as well as people with non-cancerous diseases of the head and neck.

The traditional open surgical approach requires large outside skin incisions to open up the neck and face for removal of cancerous and non-cancerous lesions. The TORS approach incorporates the da Vinci robotic surgical system to offer many advantages. With the robotic endoscopic video equipment, 3-D magnification and small instruments, the surgeon has an enhanced view of the surgical field, without external surgical cuts. This offers patients many benefits.

Advantages of TORS vs. Traditional Open Surgery:
-Less scarring, less risk of infection
-Quicker return to daily activities
-Shorter time in the hospital
-Better swallowing results following surgery
-Lower risk of blood transfusion
-No routine tracheotomy during surgery
-Depending on the presence or absence of cancer in the lymph nodes and the extent of the primary tumor, patients may need to have radiation therapy and chemotherapy following surgery.

1 National Institutes of Health, 2010 estimates for oral cavity, pharynx, larynx and tongue cancers

July 2010

Hybrid Cardiac Operating Suite Advanced Care for Heart Patients

Sentara Heart Hospital is the first in the area to introduce a Hybrid Cardiac Operating Suite. Heart patients throughout the region will benefit from this high-tech cardiac operating room that incorporates the technology of cardiac catheterization and electrophysiology labs.

The Hybrid Cardiac Operating Suite combines the very best medical expertise of Sentara cardiothoracic surgeons, electro physiologists and interventional cardiologists with the most advanced heart technology available. This unique Operating Suite expands the ability to provide less invasive heart surgery for more people with severe heart disease and/or other medical complications. It also gives the ability to offer new procedures for treating atrial fibrillation
currently not possible in a normal operating room or electrophysiology lab.

With a 56-inch HD screen in the Operating Suite and Control Room, all members of the surgery team can readily assess the patient and the progress of the treatment. Images and data from 17 different inputs – including angiograms, ultrasound, 3D electrical mapping, CT and MRI high resolution images of the heart – can all be simultaneously displayed on the monitors.

The Hybrid Cardiac Operating Suite is setting a trend around the country for this unique type of care for cardiac patients. For the future, Sentara Heart looks to offer other innovative procedures like replacing heart valves using only a catheter.

Atrial fibrillation is one of the most common cardiac problems to be treated in this new Operating Suite. This condition, where the heart beats irregularly, affects over 2.2 million* Americans and greatly increases

*American Heart Association,http://www.americanheart.org/presenter.jhtml?identifier=4451

May 2010

Minimally Invasive Esophagectomy

Surgically Removing Cancer From the Esophagus

Every bite of food placed in the mouth ends up traveling down a long muscular tube, the esophagus, leading to the stomach for digestion. Each year in the U.S., approximately 16,470 people – mostly men – will be diagnosed with cancer of the esophagus.*

Factors That May Increase Risk of Esophageal Cancer** 
- Age 65 or older 
- Being Male (3 times more than women) 
- Smoking 
- Heavy Drinking 
- Diet low in fruits and vegetables 
- Acid reflux 
- Barrett esophagus

The esophagus is nestled inside the chest cavity making the surgical removal of esophageal cancer (esophagectomy) a complicated and lengthy procedure, lasting up to 8 hours. Surgeons have to remove the cancerous esophagus then reconstruct a new passageway for food to travel.

Unlike the traditional approach where the surgeon removes the cancer through a large surgical incision in the chest, the Sentara surgeons use a minimally invasive approach that results in potential patient advantages of: less blood loss, fewer blood transfusions, a shorter hospital stay and a quicker recovery.

The procedure involves using a thoracoscope, a thin tube-like instrument with a light and tool to examine and remove cancerous tissue inside the chest. The scope reaches the esophagus through a small incision, avoiding the need to open the chest. A laparoscope is used in the abdomen to prepare the stomach for use as a replacement pathway for the removed esophagus.

In addition to surgery, chemotherapy and radiation therapy may be used in an attempt to improve the long term survival for patients with esophageal cancer.

For more information on this procedure at Sentara Leigh Hospital call 1-800-SENTARA or to learn more about the Sentara Cancer Sentara Cancer Network visit sentara.com/cancer.



March 2010

Hybrid Vascular Operating Room

New Options for Patients With Vascular Disease

Sentara Norfolk General Hospital has opened a new high-tech operating room with the latest technology that is saving and improving lives of people with vascular disease. This Hybrid Vascular OR (operating room) is the first of it's kind in southeast Virginia.

"Hybrid" simply means combining different components together. That's the concept for developing the Hybrid Vascular OR. Advanced Imaging equipment is combined with the technology used for less invasive vascular procedures and the surgical technology required for more invasive, open surgeries to create one operating room where vascular surgeons can perform the full range of vascular treatments - from simple to complex.

This uniquely designed operating room is much larger than most. The fully-equipped sterile operating room coupled with the skills of the board certified fellowship-trained vascular surgeons and the vascular-trained technicians and nurses makes it possible for a seamless conversion from a minimally invasive procedure to an open surgery should the need arise.

The Hybrid Vascular OR offers life-saving advantages for people suffering with vascular disease. As some vascular diseases don't show any symptoms until an emergency procedure is needed, it's comforting to know the vascular team is on call, 24-hours a day.

High resolution X-ray and CT imaging gives vascular surgeons the ability to see in unprecedented detail what needs to be repaired.

The Hybrid Vascular OR allows surgeons to perform less invasive surgery for more people who have complex vascular conditions that can lead to loss of circulation, hear failure, and even death, including:
     - Blockages or clots in veins or arteries
     - Abnormal narrowing or bulging arteries (thoracic aortic aneurysms, abdominal aortic aneurysms)

January 2010

Evaluating the Heart Through the Wrist

Radial Artery Access Cardiac Catheterization

Cardiologists at the Sentara Heart Hospital, Sentara Williamsburg Regional Medical Center and Sentara CarePlex Hospital are entering the body for heart catheterizations at an usual place - the wrist. The technique is called radial artery access and it offers patients some unique advantages.

Over a million cardiac catheterizations are performed each year in the United States by diagnostic and interventional cardiologists who specialize in evaluating and treating heart conditions. Traditionally this procedure begins at the upper leg area where a thin plastic tube (catheter) is inserted into the femoral artery to provide a direct route to the heart, beginning the procedure at the artery in the wrist. It takes special training for the physician to navigate this pathway and patients are enjoying the benefits of :

- A more comfortable, shorter recovery
- Reduced risk of bleeding
- Avoiding an overnight hospital stay.

Recovery is Easier
When the radial (wrist) access is used for cardiac catheterization, patients are able to sit up in a comfortable chair right after the procedure and even walk around. A clear, balloon-type wristband applies pressure to seal the artery and prevent  bleeding. Diagnostic catheterization patients are able to go home just a few hours following the procedure.

In comparison, after cardiac catheterization using the femoral (leg) approach, patients must lie flat on their backs for several hours with pressure applied to the leg to prevent bleeding. An overnight hospital stay may also be required.

The radial access technique has been used in other countries since the early 1990's, but is just now becoming more widely available in the U.S.

Radial access may be especially helpful for people who are obese or those with poor leg circulation.

For more information on physicians performing this procedure at Sentara Heart Hospital, Sentara CarePlex Hospital and Sentara Williamsburg Regional Medical Center, call 1-800 Sentara (1-800-736-8272).  Find more information on heart care at www.sentara.com/heart

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