Laser surgery now routine at Houlton Regional Hospital> Prostate, kidney sto

HOULTON — The use of lasers and video-camera equipment in modern surgical medicine remains on the cutting edge of advanced technology, both in the operating room and in physicians’ offices. Even so, two Houlton physicians are routinely using such techniques for their surgical procedures.

At Houlton Regional Hospital, Dr. Ramanadha Rao, , a urologist, and _____

______ Dr. Robert I. Mosenfelder, , an obstetrician and gynecologist, have been ______ using lasers and video equipment as part of their work since the late 1980s.

The “light knife” or laser beam used in today’s modern surgical techniques was developed in the 1960s and enables surgeons to use the concentrated light beam as a scalpel.

According to information published in the Bulletin of the American College of Surgeons, “Lasers are devices that produce intense beams of light energy by converting electricity into light beams that are further intensified to cut, vaporize or coagulate tissue.”

The article states that the key mechanism of laser action is stimulated emission radiation, a phenomenon first described by Albert Einstein in the early 1900s. In the context of the laser, radiation means light only, and not ionizing radiation usually associated with X-rays.

Mosenfelder began his private practice in Houlton in 1986. He started performing laser surgery last year on patients with problems such as abnormal pap smears and cervical lesions, in the lower genital tract.

He uses a carbon dioxide laser as part of his office procedures and in the hospital’s operating room. The laser light beam quickly heats and vaporizes tissue, removing it with microscopic precision without damaging nearby tissue.

According to the physician, the majority of the laser treatments can be performed in his office, which is less costly and more private for the patient. But, since the equipment is portable, it can also be transported to the hospital for use in the operating room if necessary.

“For most treatments, the average office visit could be from five to 30 minutes, and the patient leaves the office with only minor side effects,” he said.

Rao routinely performs two procedures with the video-camera equipment in the operating room: transurethral resection of the prostate (TURP) and lithotripsy (stone breaking) types of surgery.

Rao began performing the specialized lithotripsy surgery in 1986. This method of surgery is used to break up urethral, bladder or kidney stones, using electrohydraulic and ultrasonic fragmentation techniques. With this technique, no incision is needed on the patient.

Explaining the TURP procedure, Rao said that when a male’s prostate is enlarged, it causes obstruction to the urinary flow. To relieve the obstruction, the prostate must be operated on. The prostate is a gland below the bladder surrounding it like a collar.

“A scope is introduced into the prostate and, using a wire loop activated by electricity, the prostate is cut inside the urinary channel, again, not requiring an external incision,” Rao said.

Depending on individual circumstances, the operation takes from one to four hours. There is minimal bleeding, the patient is able to eat sooner after surgery, and generally will not need pain medication. He said that the use of video cameras and high magnification lenses during the procedure results in a safer operation for the patient.

He said new video equipment allows him to perform the entire operation through observation on a television monitor rather than through a small magnifying lens as before.

“And because the patient is given regional anesthesia, he may observe the operation on the screen monitor if he wishes,” he said.

The patient is usually released from the hospital in about two to five days.

Rao said that at most hospitals in the country, 10 to 20 percent of the prostate-obstruction surgery is still performed using incisions.

According to both physicians, the use of laser equipment has many advantages to the patient, including the fact that there is less bleeding and therefore a reduced need for blood transfusions during surgery. Also, there is less damage to surrounding tissue, the patient contracts fewer infections, no chemicals or radiation are used and the laser equipment enables the physician to work more quickly and with greater precision.