BEIRUT

Lebanon News

Innovative surgery marks first for region

  • Doctor Ramzi Alami explains how he removed a cancerous colon through a small incision on the belly button of his patient. (The Daily Star/Mahmoud Kheir)

BEIRUT: Ramzi Alami had been waiting for the right colon cancer patient to come along for a while. The surgeon was eager to perform an innovative procedure that would see the diseased organ removed through just one small incision in the belly button – an essentially scar-less operation with a quick healing time.Then last month, that person found him: a young and otherwise healthy woman who was unlikely to have complications from surgery.

“She was the perfect patient – young, thin and healthy with no heart or breathing problems,” Alami said from his office at the American University of Beirut Medical Center.

“I’d been waiting for the right patient for over a year. You have to start with an easy and straightforward case,” he said as he showed a video of the four-and-a-half-hour-long surgery.

The operation was performed at AUBMC on Feb. 12, making it the first such procedure in the region and the second worldwide. In recognition of this, Alami will be presenting a 10-minute edited version of the operation video to the annual American College of Surgeons convention in San Francisco this October.

The small incision – some 4 centimeters over the belly button instead of the traditional 30 centimeters across the entire abdomen – allows for a speedier recovery time and minimal scarring.

It was with these benefits in mind that Ruba, a Palestinian graphic designer living in Saudi Arabia, chose to undergo the operation. Diagnosed last month with colon cancer, she was determined to find the best treatment. After doing research – including a visit to a cancer center in the region – she came across Alami, whose extensive background in laparoscopic or minimally invasive surgeries made him the best person for the job.

“Has this been done before?” he recalled her asking. “I told her, I’d done it before, but not with cancer.”

The first time the procedure was completed successfully was under a team led by gastrointestinal surgeon Ovunc Bardakcioglu in 2009 at Missouri’s St. Louis University Hospital.

Alami had removed benign colons in other procedures, having spent eight years living and working in San Francisco – first as a two-year fellow at Stanford, where he got specialized training in single incision surgery, and then as a general surgeon at Kaiser Medical Center. However, he pointed out that removing a cancerous organ took special precision.

“With benign surgeries, we don’t need to go to the base. With cancer surgeries, we need to harvest the lymph nodes,” he said, referring to the small organs that play a crucial part in the body’s immune system. “We’re working close to the vital structures. This adds 10 times the degree of difficulty to the operation.”

He explained to Ruba that even if the single incision wasn’t a sufficient opening for the removal of the organ, they could always expand it during the procedure without any risk. It didn’t take much convincing for her to move forward with the operation – a decision hastened by the deadliness of her cancer.

Alami and two other surgeons – physician Faek Jamali and chief resident Maen Aboul Hosn – spent four and a half hours carefully removing the approximately 1.5-meter long colon as well as an ovarian cyst they discovered during the operation.

Ruba’s previous surgeries in the abdomen area – an appendectomy and a Caesarian section – presented a small challenge, as the doctors had to get scar tissue out of the way while they worked. In the end, last month’s surgery turned out better than they could have expected. They were able to remove 114 lymph nodes – a much higher number than most successful cancer surgeries, which only remove around 30.

“I knew we could do it, but I never knew we could do it so smoothly,” Jamali told Alami after the surgery.

It wasn’t until four days later – when test results found the patient to be cancer-free – that the doctors could really feel a sense of victory. For Ruba, that was also the moment when she realized she had a shot at living a normal life and seeing her 3-year-old daughter grow up, although Alami is quick to point out that patients are not considered fully cured of cancer until three to four years after the operation.

Speaking over the phone from her home in Saudi Arabia, Ruba said she was overjoyed with the results of the operation.

“It’s a beautiful thing. It’s one small incision on my belly, and it looks like nothing. I’m really excited. He did a great job,” she said.

Snapshots on Alami’s computer of Ruba’s stomach post-operation show a slightly inflamed reddish belly button. He points to the scar from her appendicitis operation, noting that it is much larger even though the appendix is smaller than the colon.

The AUB surgeon admitted that not all patients would be able to foot the bill for such a specific surgery, as it requires some techniques and equipment that aren’t covered by all insurance companies.

Still, he says, “I think we should do this as often as we can.”

He hopes the surgery will be used for teaching purposes at AUB, which he considers to be at the cutting edge of technology, adding, “It’s a lot more exciting coming to work thinking I can do this sort of thing.”

 
A version of this article appeared in the print edition of The Daily Star on March 15, 2014, on page 3.
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Summary

Ramzi Alami had been waiting for the right colon cancer patient to come along for a while. The surgeon was eager to perform an innovative procedure that would see the diseased organ removed through just one small incision in the belly button – an essentially scar-less operation with a quick healing time.Then last month, that person found him: a young and otherwise healthy woman who was unlikely to have complications from surgery.

The operation was performed at AUBMC on Feb. 12, making it the first such procedure in the region and the second worldwide.

The small incision – some 4 centimeters over the belly button instead of the traditional 30 centimeters across the entire abdomen – allows for a speedier recovery time and minimal scarring.

Alami had removed benign colons in other procedures, having spent eight years living and working in San Francisco – first as a two-year fellow at Stanford, where he got specialized training in single incision surgery, and then as a general surgeon at Kaiser Medical Center. However, he pointed out that removing a cancerous organ took special precision.


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