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Bloodless surgery

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"Bloodless" redirects here. For the term "bloodless coup", see Coup d'état § Types of coups.

Bloodless surgery is a term that was popularized at the beginning of the 20th century by the practice of an internationally famous orthopedic surgeon, Adolf Lorenz, who was known as "the bloodless surgeon of Vienna." [1][2][3][4] This expression reflected Lorenz's methods for treating patients with noninvasive techniques. His medical practice was a consequence of his severe allergy to carbolic acid routinely used in operating rooms of the era. His condition forced him to become a "dry surgeon".[5]

Contemporary usage of bloodless surgery refers to both invasive and noninvasive medical techniques and protocols. The term is somewhat confusing.[6] The expression does not mean "surgery that makes no use of blood or blood transfusion". Rather, it refers to surgery performed without transfusion of allogeneic blood.[7][8] Champions of bloodless surgery do, however, transfuse products made from allogeneic blood and they also make use of pre-donated blood for autologous transfusion.[9] The last twenty years have witnessed a surge of interest in bloodless surgery, for a variety of reasons. Jehovah's Witnesses reject blood transfusions on religious grounds; others may be concerned about bloodborne diseases, such as hepatitis and AIDS.

Principles of bloodless surgery

Several principles of bloodless surgery have been published.[10]

Preoperative techniques such as erythropoietin (EPO) or iron administration are designed to stimulate the patient's own erythropoiesis.

In surgery, control of bleeding is achieved with the use of laser or sonic scalpels, minimally invasive surgical techniques, electrocautery, low central venous pressure anesthesia (for select cases), or suture ligation of vessels.[11] Other methods include the use of blood substitutes, which at present do not carry oxygen but expand the volume of the blood to prevent shock. Blood substitutes which do carry oxygen, such as PolyHeme, are also under development. Many doctors view acute normovolemic hemodilution, a form of storage of a patient's own blood, as a pillar of "bloodless surgery" but the technique is not an option for patients who refuse autologous blood transfusions.

The Cell Saver is a device which recycles and cleans blood from a patient during an operation and redirects it into the patient's body, a technique called intraoperative blood salvage or cell salvage.

Postoperatively, surgeons seek to minimize further blood loss by continuing administration of medications to augment blood cell mass and minimizing the number of blood draws and the quantity of blood drawn for testing, for example by using pediatric blood tubes for adult patients.[11]

Benefits

Bloodless medicine appeals to many doctors because it carries low risk of post-operative infection when compared with procedures requiring blood transfusion. Additionally, it may be economically beneficial in some countries. For example, the cost of blood in the US hovers around $500 a unit, including testing.[12] These costs are further increased as, according to Jan Hoffman (an administrator for the blood conservation program at Geisinger Medical Center in Danville, Pennsylvania), hospitals must pick up the tab for the first three units of blood infused per patient per calendar year. By contrast, hospitals may be reimbursed for drugs that boost a patient's red blood cell count, a treatment approach often used before and after surgery to reduce the need for a blood transfusion. Geisinger Medical Center began a blood conservation program in 2005 and reported a recorded savings of $273,000 in its first six months of operation.[2]

Health risks appear to be another contributing factor in their appeal, especially in light of recent studies that suggest that blood transfusions can increase the risk of complications and reduce survival rates.[13] Thus the recovery rate is faster with bloodless surgery allowing the patient to leave earlier.

Risks

There are several documented risks to bloodless surgery that have been reported. These risks include: irreversible damage to a vital organ, anemia, tissue hypoxia, uncontrollable hemorrhage, which can lead to anoxic brain injury, myocardial infarction, bowel infarct, lung injury, or kidney failure.

Hospitals and medical centers with bloodless medicine programs

United States

California

Connecticut

Florida

Georgia

Maryland/District of Columbia

  • Baltimore

Massachusetts

Michigan

Nebraska

New Jersey

New York

Ohio

Oregon

Pennsylvania

Texas

Washington

Wisconsin

India

Breach Candy Hospital: Dr Arun Mehra and his team have been performing bloodless beating heart surgery in Breach Candy Hospital regularly. By combining innovative blood conserving strategies with specialised surgical techniques, this team has pioneered beating heart total arterial revascularisation (Coronary Artery Bypass Surgery) without giving any blood or blood products to patients.

In May 2010 HealthCare Global Enterprises Limited (HCG), Bangalore, India and medi-coin entered into a strategic alliance to create an international Center for Excellence for Bloodless Medicine and Surgery in India. There is a tremendous cost saving component that is expected to benefit patients from around the world to obtain high-tech quality care at an affordable cost. Cancer treatment including bloodless Stem Cell transplants can be performed at HCG – Bangalore, India for approximately 1/10 the cost in the United States and other industrialized countries.

Also in May 2010, medi-coin and Fortis Hospital – Bangalore, India a state-of-the-art 400 bed facility with specialties in Cardiac, Orthopedic, Neurosciences, Minimal Access Surgery and Women and Child service have entered into an agreement to create an international Center of Excellence in bloodless medicine and surgery in non-oncological specialties.

Brazil

Directories

References

  1. ^ The New York Times Oct 26, 1902 p 7
  2. ^ The New York Times Sep 10, 1906 p 1
  3. ^ New York Times Dec 25, 1902 p 3
  4. ^ New York Times Nov 22, 1926 p 3
  5. ^ Jackson et al., Baylor University Medical Center Proceedings, January 2004; 17(1): 3–7
  6. ^ Farmer S, Webb D, Your Body Your Choice The layman's complete guide to bloodless medicine and surgery, 2000 pgs. Preface, 11, 16
  7. ^ Farmer S, Webb D, Your Body Your Choice The layman's complete guide to bloodless medicine and surgery, 2000 pgs. 11, 14, 75
  8. ^ Dailey, John F, Dailey's Notes on Blood Fourth Edition, 2002 pg. 198
  9. ^ Farmer S, Webb D, Your Body Your Choice The layman's complete guide to bloodless medicine and surgery, 2000 pgs. 144-5
  10. ^ Goher et al., Ann R Coll Surg Engl 2005; 87: 3–14
  11. ^ a b Magner, David (2006). "Pancreaticoduodenectomy after neoadjuvant therapy in a Jehovah's witness with locally advanced pancreatic cancer: case report and approach to avoid transfusion". The American surgeon. 72 (5): 435–437. PMID 16719200. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  12. ^ Time Magazine, Bloodless Surgery, by John Langone, October 1997; page 5 [1]
  13. ^ Baseline of Health Foundation-Jon Barron
  • No Mans Blood by Gene Church (1983) ISBN 0866661557

Further information about bloodless surgery

[Evidence in favor of bloodless surgery mounts]http://www.digitaljournal.com/article/281102

See also

  • Knocking, a documentary on Jehovah's Witnesses that features a bloodless liver transplant
  • Autotransfusion, - the process of returning to a patient their own blood that has been lost.
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