The Kindest Cuts of All

Like a kid intent on a Nintendo game, Dr. David Sugarbaker looks not at the patient lying senseless on the operating table but at the TV positioned by her side. "I think we're right on target," he exults. Displayed on the screen is a larger-than-life section of the woman's right lung, a rosy mass marred by a couple of suspicious lumps. "Fire away," Sugarbaker directs the assisting surgeon. On the screen a tiny pincer appears. Grabbing hold of the lung just above the lesion, the pincer makes a clean slice through the quivering tissue, simultaneously sealing the wound by laying down a triple row of surgical staples. A few more snips and the task is complete. Sugarbaker, chief of thoracic surgery at Boston's Brigham and Women's Hospital, draws a 10-cm-long sliver of lung through a finger-size hole in the patient's side and sends it for biopsy.

This nearly bloodless procedure, which Sugarbaker began performing just nine months ago, is one of the most recent applications of a new approach to surgery that is rapidly displacing the dreaded knife and scalpel. "We are witnessing the greatest surgical revolution in the past 50 years," exclaims Dr. William Schuessler, a urological surgeon from San Antonio. The instrument sparking such enthusiasm is variously known as a laparoscope (when used in the abdomen), an arthroscope (when applied to the joints), a thoracoscope (when the chest is involved) and an angioscope (when the target lies inside blood vessel walls). But apart from differences in length and thickness, all these scopes are fundamentally alike: slender fiber-optic tubes that can be inserted deep inside the body through minute (1-cm-long or less) incisions. With the addition of a tiny telescopic lens, a miniature light source and a palm-size video camera, these tubes are transformed into videoscopes that project images of the patient's internal organs and, even more important, of the snippers, staplers and graspers that the surgeons manipulate.

The reason for the surging popularity of videoscope surgery is simple: correctly performed, it can dramatically reduce surgical trauma. Since 1987, when the first diseased gall bladder was removed in this fashion, rave reviews from patients have made it almost rare for a gall bladder to be removed the old-fashioned way. And for good reason. "Before," says Dr. Eddie Joe Reddick, a retired Nashville surgeon credited with popularizing the technique, "we were committing assault and battery on our patients. It wasn't what we did to their insides, but what we did in order to get there that was the problem." Now, instead of an 8-cm to 15-cm slash down their abdomens, patients wake up with four small incisions that not only heal more quickly but also are far less painful. In fact, most patients whose gall bladders are removed laparoscopically leave the hospital the next day and return to work within a week.