In today’s world of complex diseases and cancers, successful surgery alone is not important. Because major surgeries cause major blood losses and requirements of blood transfusion. Especially in cancer surgery that causes multiple harmful effects like early return of cancer and it’s antecedent problems causing earlier death and bereavement to families. This is because it is evidence based that blood transfusion causes immune suppression and also transmission of deadly viruses like HIV and Hepatitis B and C and also gross changes in body in terms of calcium metabolism and acid Base electrolyte disturbance. Massive blood transfusions cause coagulopathy leading to more bleeding, more blood transfusion and vicious cycle leading to death.
In this Point of view DR. Suddhasattwa Sen, renowned gastro intestinal surgeon of the country and Jt. Director & Sr. Consultant, GI HPB and GS Dept. Medica Super specialty Hospital, Kolkata has said on the concept of “Non transfusion surgeries and bloodless surgeries “. In this operations, the major hepatobiliary pancreatic stomach oesophagus and colorectal cancers are done so meticulously with help of better tissue handling and better and judicious use of technology like diathermy harmonic stapler etc. that the blood is so minimum that patients won’t require transfusion which leads to less complications , better survivals and in cancers , better disease free survival.
- Sen has said that we have started this so called ” Transfusion free surgeries or bloodless surgeries where no allogeneic ie. Someone else’s blood is transfused”. We have been doing hundreds of very critical difficult surgeries over last 5 years (many of which had been unique in the world and already published in major newspapers and elsewhere.) and with more and more time this will become a standard of care in high volume tertiary level surgeries.
The use of technology has also helped in hepatobiliary pancreatic cancer and non-cancer surgeries which are being regularly practiced in Eastern India at par with world standards without significantly increasing costs. The advances are primarily 2 fold:
- Advent of laparoscopy surgery (microsurgery) now being done for advanced problems of liver bile duct pancreas spleen stomach colon rectum and even anus (way surpassing the regular microsurgeries like gallbladder stone or appendix, hernia even for piles.). Even major hepatobiliary pancreatic stomach colorectal cancer surgeries are possible with microsurgery. Nowadays it is routinely done based on case selection.
- The advantage of microsurgery on HPB system is not just lack of large scar or absence of relative pain but also earlier return to work due to less exposure of inside organs to atmosphere since operation is done in closed space of abdomen distended by gas. The surgical trauma is also less giving rise to better tolerance of patients to very major traumatic operations.
However it needs a very high skill level, fitness of surgeon, experience and training of surgeon and also a much synchronised team.