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Healthcare cost cutter: new laser gallbladder surgery slices recovery time increasing business productivity.

Healthcare Cost Cutter

On March 23, general surgeons Frank Ludwig and John DeLoach made medical history in Arkansas. They performed the state's first laparoscopic laser cholecystectomy to remove a gallbladder at Baptist Memorial Medical Center in North Little Rock. Although it sounds esoteric and arcane, with over a half million gallbladder surgeries in the U.S. each year, the new procedure is considered by some as the biggest advance in general surgery in the last 15 to 20 years.

Patients are already singing its praises. There's much less pain with the new surgery, and the recovery time is much shorter. And soon both business and industry are expected to join this hallelujah chorus because the laser procedure has the potential to drastically lessen the impact of lost work productivity and save more than 30 million work hours annually in the U.S.

Although technology for the new procedure has been around for more than 20 years, it was primarily used by gynecologists. Only recently have general surgeons begun to look for new ways of using these space-age lasers.

Less Than Two Years Old

Dr. Eddie Joe Reddick, a Greene County native and 1975 graduate of the University of Arkansas for Medical Sciences, pioneered the development of the laparoscopic laser cholecystectomy and performed the first one in 1988 at Centennial Medical Center in Nashville, Tenn.

The traditional method of removing the gallbladder requires a five to six inch incision, a five to six day hospital stay and a six week recovery period. But laser surgery requires only four small punctures in the abdomen, generally only one day of hospitalization, and patients are able to resume normal activities after one week. With gallbladder surgery being the most common surgery in the U.S. each year, the potential impact on business and industry is staggering.

At Baptist Memorial Medical Center alone, 221 cholecystectomies, or gallbladder removals, were performed in 1989. Some number crunching done by the hospital's administrative staff estimates that those surgeries were responsible for approximately 16,600 lost hours of work productivity in 1989, based on the following data: 50 percent of gallbladder cases meet the medical criteria for the laser procedure; 75 percent of such operations are performed on persons between 21 and 65 years of age; and, conservatively 65 percent of that age group are employed, according to the Arkansas Employment Security Division.

The hospital conservatively figured an average recovery period of five weeks, meaning that the lost hours of productivity for those 221 cases would be decreased by 80 percent - 13,280 hours - for patients having the new surgery. Using the same methodology, the new surgical procedure could save an estimated 30 million work hours nationally. Since many of these workers would be entitled to reimbursement of lost income through disability insurance, the new procedure also has the potential to save the insurance industry millions of dollars each year.

Pain And Suffering

Accounts from patients who endured the old gallbladder surgery, compared to those who sailed through the new high-tech procedure, are testimony to the laser's expanding possibilities.

Take, for example, Flo Glass of Little Rock. When she had her gallbladder out in the early '70s, she endured excruciating pain from a scar almost a foot long and stayed in bed and on the sofa three weeks. It took several more weeks before the then 23-year-old woman felt well enough to return to normal activities.

"It was the most horrible surgery I had ever had, and I've had just about everything taken out," she says. "The pain was horrible. You couldn't raise up, all the muscles in my stomach had been cut."

When she was told about North Little Rock mail carrier Joe Uselton's recent gallbladder surgery, performed at Baptist Memorial Medical Center, she was awestricken and more than a little envious. At age 40, Uselton had his gallbladder removed as an outpatient and returned to work a week later, carrying the mail and walking every inch of his route.

"The only problem I had was the anesthetic, that took about two days to wear off," Uselton says. "As soon as that wore off, I was fine. I had absolutely no pain, none at all."

In addition to Baptist Memorial Medical Center, the procedure is now being offered at Baptist Medical Center, Doctors Hospital and St. Vincent Infirmary Medical Center and will soon be offered at UAMS.

During the procedure, the surgeon makes four small incisions, less than half an inch in length, in the patient's abdomen to pass a laparoscope and other instruments through.

The abdomen is then inflated with carbon dioxide to create a space. Then a laser fiber is inserted through the scope, and the laser cuts away the gallbladder. The gallbladder is removed through a tiny incision in the navel.

The laser is used much like a scalpel, and there is no room for error. It is a 1000 degree centigrade instrument that could quickly burn a hole in someone. During laser surgery the surgeons are looking at a television monitor rather than into an opening in the body. "Everything is done by remote control," says DeLoach.

Laser surgery is more expensive than traditional gallbladder surgery, but the savings factor applies to the bill for hospitalization. The customary charge is about $1,200 for the surgery, says DeLoach, but the new procedure, which takes twice as long as the old one, costs about $1,900.

However, the hospital bills for the traditional cases run about $6,500, says Tommy W. Kidd, manager GI Lab/Surgical Services at Baptist Memorial Medical Center, compared to about $4,000 for patients who undergo the laser procedure.

"When we bought the laser, we weren't thinking gallbladder, it was bought for GYN surgery," says Kidd. "But these two guys thought it was worth looking into. They saw how great it was and came back (from a seminar in Denver), and we got the instruments together to do it. Since then they have found other applications for the surgery."

Other applications include the removal of tissue responsible for abnormal uterine bleeding and hemorrhoidectomies. Ludwig says he and DeLoach are looking at using the laser on vericose veins.

"It's being used by plastic surgeons and the gynecologists," says Ludwig, who adds that he doesn't think the laser will ever completely replace the scalpel. "The main thing we're interested in is relieving pain, these patients have have miniscule pain compared to the traditional gallbladder surgery."

"It's harder to do than a regular gallbladder. No doubt about it, but you get use to it," says DeLoach. "It's a totally different way of operating."

DeLoach predicts that 80 to 90 percent of all gallbladder surgery will be done with the laser within three years, "because the patients will demand it."

"If I had to have mine out, that's the way I would do it," he says. "This is the best mouse trap yet."

Jan Meins is a freelance writer living in Cabot.

PHOTO : HIGH TECH MEDICINE: Laser gallbladder surgery breakthrough. Photo courtesy of Baptist Medical Systems.

PHOTO : STOPPING PAIN: Laser gallbladder surgery. Photo Baptist Medical Systems.
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Author:Meins, Jan
Publication:Arkansas Business
Date:Jul 2, 1990
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