Monday, July 28, 2003

Med Tech

Less invasive, less fat

By Dyke Hendrickson

A Massachusetts General Hospital surgeon has combined a new, new thing (laparoscopic surgery) with an old, old problem (obesity) to create a thriving national practice at the hospital.

Short-term result: a waiting list of 1,600 patients.

"Dealing with obesity is a very fast-growing segment of surgery," said Dr. Janey Pratt, whose minimally invasive procedure is proving attractive to overweight Americans throughout the country. "You could have every surgeon in the hospital operating every day, and you wouldn't be able to reach all those who seek help.

"This is not cosmetic surgery. It is for people whose health is threatened. And there are many who seek it."

Pratt is part of the Mass General Weight Center, which has been designed as a multidisciplinary practice to address all aspects of obesity in adults and children.

She has emerged as the team leader in the laparoscopic technique. Laparoscopy is the use of slender, tubular instruments called endoscopes inserted through an incision in the abdominal wall to perform minor surgery.

Patients prefer this procedure because it does not require the midsection to be cut open. Medical administrators support it because the risk is less and the recovery time shorter.

Pratt didn't become an expert by accident. She had been on a course to become a pediatric surgeon when Mass General officials asked if she'd train for work in their new obesity program.

She won a grant from the nonprofit Center for Integration of Medicine & Innovative Technology (CIMIT) that enabled her to take time from full-time work to develop new surgical skills.

It is a local consortium of research institutions founded by Partners HealthCare System, Massachusetts General Hospital, Brigham and Women's Hospital, MIT and Draper Laboratory. The newest affiliate is Beth Israel Deaconess Medical Center.

CIMIT officials say their mission is to improve patient care by bringing together scientists, engineers and clinicians to "catalyze development of innovative technology, emphasizing minimally invasive diagnosis and therapy."

Pratt's technique emphasizes the minimally invasive therapy. And it has taken a lot of work. Since the cavity has not been cut open, the surgeon must operate by following visual leads and demonstrating a deft touch.

"Learning (laparoscopic techniques) was really hard," said Pratt, a Maine native who attended Wellesley (1988) and Tufts Medical School (1993).

"I trained for months, then did my early work on pigs. The pigs didn't fare well, but I did. I learned a lot."

Pratt has been working on the newest innovation of bariatric, or obesity, surgery - a less-invasive procedure called the Roux-en-Y Gastric Bypass (RYGB).

Her technique fosters weight loss similar to those of a gastric bypass surgical procedure, which has been performed since the 1960s.

The gastric bypass separates a part of the stomach into a pouch the size of a shot glass, according to industry literature. People feel full once the pouch is filled up, after just two or three bites of food.

The pouch connects to the small intestine brought up to it from the mid-abdomen. This part of the intestine cannot process concentrated calories found in sugar and fat, so these foods can cause nausea, queasiness, fast heart rate and general discomfort that is not dangerous.

There are surgeons at Mass General, and many other hospitals, who cut open the patient to facilitate this bypass procedure in a process also known as stapling.

But Pratt is among the first to execute the procedure with slender tools that involve minimal shock to the body.

Industry statistics suggest at least 15 million Americans are obese as defined by the body mass index (BMI, see chart this page). Generally, an individual is at least 50 pounds overweight to qualify for the surgery.

However, some of Pratt's patients carry 100 to 200 pounds of extra weight.

After the procedure, the patient needs two to three days to recover. Industry authorities say there are fewer pulmonary complications and a significant decrease in infections and hernias.

"When I started my career, I was going to operate on babies, the smallest people," Pratt said.

"Now I am operating on the largest. It provides great satisfaction, though, because you can see immediate and long-lasting improvement in your patient."