Bloodless Surgery

isaacbowman writes "Dr. Charles Bridges, a Pennsylvania Hospital cardiologist, says says regarding new bloodless surgery options - "Among the benefits are reductions in recovery time, hospital stay, cost and complications -- as well as an estimated $20,000 in savings per patient." Advances in medicine have made this possible and Dr. Bridges also says, "There's no downside to it that we can see, and there's certainly no downside that's been documented." Dr. Patricia Ford, director of Pennsylvania Hospital's Center for Bloodless Medicine & Surgery, further states, why blood transfusions are dangerous, saying that they are "like getting a transplant; they can be risky and should be a last resort.""

I'll bet

$20,000 in savings per patient

That dull roar you just heard outside was the US's entire population of medical residents placing a revolver in their mouth and pulling the trigger.

Re:I'll bet

That dull roar you just heard outside was the US's entire population of medical residents placing a revolver in their mouth and pulling the trigger.

And there goes the $20,000 savings per patient...

Re:I'll bet

Hardly... The savings is realized in two ways.
1. Less risk so the doctors insurance cost are less (SOME of this savings will be passed on to you)
2. Quicker recovery time so your hospital room stay will be shorter. This only means quicker turn around time s

Re:I'll bet

Hi. Welcome to corpoatism. None of the savings will be passed on to you, or to the doctor. The CEO of the malpractice insurance corp will get a bigger bonus.

Re:I'll bet

I agree with #2, but #1? If there is any universal truth, it's that insurance bills never go down!

Re:I'll bet

tell that to my insurance company, my bill keeps going down!

Re:I'll bet

Feyr, I'm sorry to tell you this, you must have died 3 years ago and they are just tapering off your payments.

They've obviously compensated in some way

and keep the medics' earnings up otherwise they will not have said there is no downside.

How do they get a 20k saving per patient? They must be selective in what they're quoting because most surgical procedures cost way less than 20k.

Re:They've obviously compensated in some way

Odds are good the '20k in savings' is either an average savings (and hence including the ever-expensive organ transplants and other risky surgeries) or else it's a cumulative savings from the following:

• Red Cross doesn't have to expend as much effort into

The sad part...

The sad part is that this procedure works only on Vulcans [wikipedia.org].

Transfusion != Transplant

As a surgical resident I found most of the article pretty good, but the last line that a blood transfusion was the same as a transplant much have been taken out of context. I have take care of nearly 100 transplant patients during my residnecy and they are by far the most labor intensive petients in the hospital. They are chronically immune suppressed, often on the verge of liver and/or kidne failure, and generally coming in erey year or so with rejection issues.
On the other hand I have taken care of hundreds of patients who have had blood transfusions. While not harmless, a blood transfusion has a miniscule risk of infection (from potential pathogens we are not aware of or cannot test for) or reaction. Only two of my patients have had transfusion reactions which requires stopping the transfusion, some medication, and maybe two extra hospital days. These patients did not need long term immune supression or chronic doses of borderline toxic medications as a result of the transfusion.

Just my little nit pick with the article.

---sam

thinking too literally

You are thinking too deeply, their point was simply whenever possible one should avoid inserting things into the body that are foriegn, either other peoples blood or even your own blood that has been stored.

It also avoids potential problems like this [bbc.co.uk]. (synopsis: Red Cross Canada pleads guilty to killing over 3,000 people due to distributing tainted blood; 1000 contracted HIV, 20,000 hep-c). The less foreign substances you put in your body, the better, besides the fact that stored blood isn't nearly as effective as your own natural blood at carrying oxygen.

Re:Transfusion != Transplant

I agree, but this is mostly due to the fact that the transfused blood cells quickly die off and are discarded by the body, replaced by the host's own blood cells. The implanted organs are supposed to survive for years, and thus are a constant source of irr

Re:Transfusion != Transplant

I did my internship at Pennsylvania Hospital. The bloodless program is great. I think Pat Ford's quote is a little much, but, on the other hand, blood transfusions are more than just an issue of a little transfusion reaction. There are a number of other antigens on the cells (besides those for "blood type" with which can people react. The trouble is, this can raise the risk of transfusion reactions later on in life, if the need arises for another transfusion. Folks who need transfusions chronically for some reason or another can get to the point where you have to test for all kinds of antigens, then wait 3 days for that one unit of blood to come from Louisiana. In general, you definitely want to limit the number of times that you get transfused, so that when/if you really need the blood, you won't have a problem. All you need is to have some horrible motor vehicle accident, get 10 units of blood, then get a hemolytic reaction on top of your other problems.

BTW: Jehovah's Witnesses vary in terms of their religious beliefs around transfusion. For some, some components of blood can be transfused, but not others, whereas other patients are more stringent.

Re:Transfusion != Transplant

The official position of the church is that you cannot use any of the major blood fractions (red or white blood cells, plasma or platelets), but the use of certain blood fractions (animal hemoglobin, interferon, interleukin, etc.) is left up to personal conscience.

A handy chart for the various blood related things JWs may or may not use can be found here [adam.com].

Re:Transfusion != Transplant

Yeah, whilst these are also all valid, much of the time it's more simple - that the patient doesn't understand what's been written. They might see a "scrawl" because they're /expecting/ a legible word, when what is actually written may be:

"2tbdiafuf"

Or:

Old technology

"Keyhole surgery" generated some fanfare a few years ago, but the reality is that it is more dangerous than open surgery, requiring greater skill. How the hell do you operate on something you can't see, digging around under flesh?

Re:Old technology

How the hell do you operate on something you can't see, digging around under flesh?

It's easy. Say "marco" and the diseased part will answer "polo", guiding you to your destination.

Or maybe use ultrasound or a floroscope. The marco polo thing is way funner

Re:Old technology

you can see. Them little fibre optic camera gizzmos have been around for at least 30 years.

Old, but modified and state of the art tech

In many (not all) cases "keyhole" surgery (laparoscopic - in the belly, or Arthroscopic - in a joint), actually allows a BETTER view than the traditional open procedure.
Every joint procedure (knee or shoulder 'scope) allows the surgeon a better view than the open method,'cause the camera is so small, it can get into many places, that you normally can't even see. Gallbladder surgery now is overnight or same day, as compared to a one to two week stay for the open method.

And yes, I am a surgeon , and I have done both open and closed shoulder repairs, and the 'scope method is waaaaay better. You can see more anatomy, more pathology, less blood loss, and less tissue damage. Trust me, we all need to sleep at night, and want what's best for the patient.

Don't get too exited.

I can guarantee you, the only party involved in the process who will see that twenty grand is the insurance industry.

M

stalone predicts the future... again

after bloodless surgery comes fluidless sex [wikipedia.org].

Bloodbank tech says: YEEEHAH!!!!!

"Among the benefits are reductions in recovery time, hospital stay, cost and complications -- as well as an estimated $20,000 in savings per patient."

Not to mention stretching the blood supply for the patients this doesn't help ... a 27-unit obstetrica

$20,000 per patient! - more like $500 per unit

At least that's what most hospitals charge to the patient for predonated blood.
.
That $20,000 sounds like it's been pulled out of someone's exagerated butt - maybe for a very, very, very bloody heart transplant. Probably >90% of operations don't require a blood transfusion.

I'm an orthopaedic surgeon, and for those of you who don't know, most orthopaedic surgeries tend to resemble Aztec ceremonies. But anyway, my last 20 knee and hip replacements haven't required a transfusion. Most patients who do need a transfusion - i.e. bloody messes scraped off the pavement after being ejected from their car wreck, only need about 2-4 units.

Would it be cool if we found a safe, effective blood substitute? - yes. But today the risks from transfusion are approximately 1 in 350,000 of being exposed (not catching) hepatitus, and 1 in 2,000,000 exposure to the HIV. In other words, don't worry about it, your risk of being hit by lightning is about the same.

Re:Bloodbank tech says: YEEEHAH!!!!!

And here is another way to stretch the blood supply Automated Blood Collection [stanford.edu]. So next time instead of giving whole blood, check out apheresis, and see your donation go to help more people, more often.

Boosting the parent visibility - this is a good i

JW article on Bloodless Surgery

If you really want to investigate why bloodless surgery is gaining ground in the medical industry then take a look at this article published by Jehovah's Witnesses. And before you turn up your nose because of the source of the article, you should really give it a read. The JW's have had a major impact on how the medical industry views this topic and many advances have been made because of them. Here's the article: http://www.watchtower.org/library/hb/index.htm?art icle=article_06.htm [watchtower.org]

Re:JW article on Bloodless Surgery

Speaking from personal experience, my mother-in-law ruptured her spleen and didn't go to the doctor for 2-4 weeks. (She didn't know when she ruptured it.) She bled internally for this entire time, eventually ending up unconscious in the Emergency Room from blood loss, where they decided it needed to be removed. My in-laws are extremely devout Jehovah's Witnesses, and refused any sort of transfusion. The doctor told my father-in-law "Your wife will die without a transfusion. She's lost too much blood." They opted for blodless surgery anyways.

Keep in mind that I do not personally subscribe to these beliefs, but this is what I, as an outsider, observed: (Anecdotal, yes, but it's all I have to go on.) They called in their best surgeon. The surgery took much longer than a "normal" splenectomy. The surgeon took extra time and went slow. All the internal sutures had to be extra clean to avoid blood loss. Even the external sutures were done with great care. They were so careful with blood loss that she lost less than half a pint of blood through the whole procedure. (Almost all of that half-pint was in the spleen, or so the surgeon said.) My mother-in-law survived the surgery. (although it was pretty dicey for about 24 hours - the hospital told the family to make sure her "affairs were in order.") She recovered in record time. No complications. Even the scar was less visible than a typical surgery scar.

So regardless of religious views, it seems to me that if you request a bloodless surgery, you get better medical care. Rather than trying to chop you up and sew you back together as quickly as possible to free up the operating room for the next job, everyone involved seems to slow down and take things easy. You become that pain in the ass exception that they need to take extra special care of. Rather than run you through the mill, they have to take you off the assembly line, look at your special needs. I still doubt that I personally would opt for a bloodless surgery, but it really gave me pause to think about the whole idea.

Re:JW article on Bloodless Surgery

While the "chop you up and sew you back together" paradigm may seem like it is out of greed on the part of the surgeons, decreasing surgery time does prevent many benefits to the patient as well. Simply having the surgery site open for less time would, in theory, lead to less complications due to blood loss, tissue oxidation and contamination. Surgical anaesthetics are not "good for you" and the less time spent on the table, the lower the risk from complications with these chemicals.

Re:JW article on Bloodless Surgery

They called in their best surgeon. The surgery took much longer than a "normal" splenectomy. The surgeon took extra time and went slow.

So regardless of religious views, it seems to me that if you request a bloodless surgery, you get better medical care.

Cool stuff

I think it's brilliant that they're starting to use suctioned blood to resupply the patient. This is, more or less, perfectly good blood. It may need to be mixed with some anticoagulants, but otherwise it's got to be better than transfused blood. It's fresh and still plenty capable of carrying a full load of oxygen.

I'm planning on applying to med school in the next couple of years with the goal of going into surgery, so seeing an article like this on Slashdot is nice. The advancements in medicine over just the last decade have been incredible and I see no end to it. I'm looking forward to how much more it will advance by the time I'm in residency.

Re:Cool stuff

I used to have a job running a Cell Saver for a third party company during surgical procedures. It does provide a great benefit to the patient (as they're getting their own blood products back almost immediately, frequently while still partially oxygenated) WHEN USED PROPERLY. Most of the time it didn't eliminate the need for transfusion (especially in trauma cases, or abdominal aortic aneurysm cases which made up about 50% of our work) but frequently the blood would have to be discarded due to procedural contraindications, ie the surgical team (read as: the surgeon) would not follow the instructions given by the technician (namely, me.) I literally had one doctor suck up stomach contents into the cell saver reservoir and then be irate when I refused to process it. Another time, written instructions on an emergency reservoir setup (to be used in cases where it's needed immediately for an emergency surgical procedure, before the technician can arrive at the hospital) were not followed (in this case, the wall suction was set to "full" which destroys red blood cells and can lead to an increased risk of heart attack and/or stroke among other potentially fatal complications) leading to nearly 3 liters of suctioned material being discarded. The cutter complained to the cheif surgeon, who complained to the head of surgical services, and after a protracted investigation, it was determined that it was the right choice. Nevertheless, the same mistake was made multiple times at the same hospital after that, and despite my having made the right choice in insisting the material be discarded, that surgeon refused to allow me to be in the room while he operated after that. (Yay for surgeon arrogance; even when he's wrong, he's right.)

My point is that the cell saver is not a panacea for transfused blood. We did use it on several Jehovah's Witnesses; apparently there is some thought that if the circuit of blood is not broken (ie the suctioned material is constantly processed and immediately transfused) then there is no breach of their belief system.

Isn't that just surgery

on a lawyer?

Oblig. Star Trek reference

Glad to see the doctors are finally putting away their butcher knives! :P

Not just for religion

Okay, yes, good on Jehovah's Witnesses for reinforcing the desire for these types of procedures, but stop and think that this might not just be a religious issue. Theres a whole 7% of the population out there who, like me, are type O negative. And while we may be wonderful/magical/mythical creatures capable of donating our blood to anyone other human being on the planet (especially handy during time-critical emergencies), we are unfortunately incapable of accepting red blood transfusions from anyone BUT an O- donor.

So this is also good news to some of us who may be concerned with limited supplies of compatible blood in an a system already struggling to meet demand. Hooray.

Obligatory(?) Merchant of Venice reference

This is bad news for Antonio, and Shylock will be quite pleased.

Re:Bloodless Surgery?

How do you cut open someone's chest to fix a heart valve without there being blood?

Vampires.

KFG

Re:Bloodless Surgery?

Well, either that or morticians.

Re:Bloodless Surgery?

Yes ... personally I thought Van Helsing was a pretty decent movie. If you're into that kind of film (I most certainly am) I think you'll enjoy it. Besides, Kate Beckinsale is most impressive. The final battle is one of the best choreographed CGI fight sce

Re:Bloodless Surgery?

From TFA:

• The patients have the iron content in their blood enhanced in order to better cope with the procedure (same as in a blood donation).
• During the surgery, various non-bleedy and less bleedy techniques (such as cauterizing as you cut, and freezing the tissue to stop blood flow) to reduce the amount of blood you lose in the first place.
• They recover what DOES get spilled and recycle it so you use your own blood during the procedure instead of having to donate in advance.

The artices does go ahead and admit that the more complex a procedure, the less likely this is possible: so a full-on heart transplant is far less likely to be bloodless than, say, an appendectomy or a stomach reduction (or other similar surgeries that don't require large incisions).

Re:Bloodless Surgery?

Yeah that got me for a while too... by bloodless it more means blood-transfusion-less; there is obviously blood involved, but only the patients own.

Re:Driving force for bloodless surgery

As one of Jehovah's Witnesses who has twice faced a serious blood-loss I can tell you how happy I am to see advances like this. Actually as a Witnesses, we give a lot of credit to courageous doctors who took on difficult cases without having the option of transfusing. The issue is actually surprisingly broad -- involving things like informed consent and various patient rights concerns. In regards to blood being a vector for pathogens, this is certainly well known, but our stand is purely religous based (based on the Biblical mandate expressed in Acts 15:29 and elsewhere). In my own case I was so glad to have avoided a transfusion in Canada during the early 80s, just before the AIDs-tainted blood supply issue became known. Canada was behind other countries, such as the US in implementing AIDS/HIV testing to routine blood screening. Ironically, even though I know live in the US, I had an accident while on vacation in Canada in 2001 which required emergency surgery. I can tell you that while I did fine, many hospitals in Canada simply can not afford some the equipment mentioned in the artical.

Re:Driving force for bloodless surgery

Speaking as someone who has family members who are Jehovah's Witnesses, they really are the driving force for bloodless surgery.

Jehovah's Witness have a theological objection to blood transfusions [watchtower.org], but unlike Christian Scientists, not to medical treatment in general. In fact, they are quite insistent on high quality healthcare [watchtower.org].

As such, they advocate [watchtower.org] the use of blood transfer alternatives.

There are various groups of Witnesses that advocate changing the doctrine [ajwrb.org], but, however odd it may seem to the rest of us, it's one of core teachings of the church and has survived even when other once-rejected medical technologies (organ transplants, certain immunizations) have now been accepted.

This doctrine has caused the Witnesses to push the medical community to come up with many alternatives to transfusion. These alternatives include Erythropoietin Therapy [nejm.org], Hemopure, a bovine-hemoglobin based blood substitute [anesthesiologyinfo.com] (this was quite a surprise, as previously even animal blood was considered taboo), perfluorocarbon based blood substitutes [watchtower.org] (back when I was young, I knew Witnesses who had been guinea pigs for this stuff), and a host of others [adam.com]. There are also specific surgical guidelines [unipi.it] published in dealing with Witnesses.

All in all, the Witnesses are one of the main driving forces for research into lessening the need for blood transfusions. There are others to be sure (type matching, blood shortages, infectious diseases carried by tainted blood, etc.), but nothing beats having a large pool of otherwise healthy patients who are highly motivated to be test subjects.

Re:Driving force for bloodless surgery

Jehovah's Witness have a theological objection to blood transfusions, but unlike Christian Scientists, not to medical treatment in general. In fact, they are quite insistent on high quality healthcare.

I work in one of the US' big children's hospitals in the neonatal ICU. Right now I'm watching a one month old 34 week gestation boy with a transposition of the great arteries slowly die because of these objections along with a bunch of treatment knots. This belief is utter nonsense. And if you don't believe me, come and watch this life of this little guy slowly ebb away as he struggles and struggles. You look into his eyes and tell me giving him blood will damn him.

Re:Driving force for bloodless surgery

I completely agree with you, and sympathize with the anger and frustration you must feel. While much of my immediate family are Jehovah's Witnesses, I am not. Because of this fact, they have not spoken to me for 14 years.

I'm not overly fond of many of teachings of the church, but I'm also cognizant that most every religion has its nutty aspects. JWs also tend to be very nice and honest people, and live lives of moderation that tend to reduce their need for medical assistance, all of which are also a requirements of the church. It's a very mixed bag.

Unfortunately, rationally looking at your own religion is not a strength that many possess.

Re:Driving force for bloodless surgery

That all depends on your faith. You see, some people have such faith in their beliefs that they are willing to die for them, by abstaining from any kind of blood. Many people have a problem with this. But remember, Jehovah's Witnesses are simply messenger

Re:JW's must be happy with this one

This is all very inside-baseball, but considering that all but a maximum of 8,524 [watchtower.org] of the 144,000 are supposedly dead, and those are all well into their 80s, I don't think much jumping is going on... :)

For those of you who are curious, Witnesses split th

Re:JW's must be happy with this one

Argh! Only 8,524 are still alive. Most of the 144,000 (if you believe such things) are dead (but alive in heaven).

Re:Interesting tech

Basically the scalpel consists of a handle, an on/off switch aka. an Activation Matrix, a blade arc tip and a stabilizing ring. By directing energy through crystals stored in the handle of the scalpel an arc wave energy field is formed as the blade. This extremely powerful "light" scalpel cauterizes wounds as it cuts. However it must be noted that to use this tool a surgeon must be well endowed in the "force"

It's called a Bovie - electrocautery 50 years old

Pretty much ALL surgeons use it a lot! Originally invented in the 1940s? by a Neurosurgeon, it uses high frequency electric arc to cut, or cauterize tissue to a patient who has been grounded.

Re:"Harmonic" Scalpels

"Minimal smoke for improved visibility in the surgical field"

Although I can see how reduced loss of blood can help recovery, I have to question how well the cut parts stick back together when they advertise "minimal smoke" as a selling-point.

"Hey Jonse