New method to cut risk in gallbladder surgery

There are 800,000 procedures carried out in the US alone each year, which means that 4,000 patients there will be seriously injured.

By JUDY SIEGEL-ITZKOVICH
Doctor [Illustrative] (photo credit: INGIMAGE)
Doctor [Illustrative]
(photo credit: INGIMAGE)
Laparoscopic cholecystectomy is a minimally invasive procedure for gallbladder removal, and one of the most common surgical procedures worldwide.
While the procedure has a very high success rate, one in 200 patients will sustain serious bile- duct injury, mostly due to misidentification of the biliary anatomy.
There are 800,000 procedures carried out in the US alone each year, which means that 4,000 patients there will be seriously injured.
Current attempts to simplify identification of the bile duct rely on intravascular injection of contrast agents and fluorescent dyes, which significantly increases the duration and complexity of the laparoscopic procedure.
For this reason, these technologies are rarely used.
Members of the BioDesign: Medical Innovation program, created by the Hebrew University of Jerusalem and its affiliated Hadassah University Medical Center, set out to develop a solution to this problem. The program is directed by Prof. Yaakov Nahmias, director of HU’s Alexander Grass Center for Bioengineering, and Prof. Chaim Lotan, head of Hadassah’s heart institute.
“The laparoscopic procedure is so simple and fast that surgeons are reluctant to make it more complex by adding new imaging modalities,” said Dr. Muhammad Adileh, who led the BioDesign team. “We had to find a solution that wouldn’t complicate things by changing the procedure or increasing operation time.”
The team identified a unique spectrum of bile acid absorption. “We found that red light in the visible range is predominantly absorbed by bile acids in the biliary tree,” said Nahmias.
Animal experiments showed that the team was able to identify bile ducts just by switching the color and direction of incident light. “This is a significant discovery,” said Nahmias, “allowing surgeons to carry out the standard laparoscopic procedure and identify bile ducts with a single flip of a button.”
The project, called CholeVision, will culminate in a dedicated laparoscopic tool that would allow surgeons to avoid bile duct injuries and their devastating consequences.
The BioDesign business development team, led by MBA students Rotem Yarkoni and Asher Saban, noted that insurance claims amount to $1 billion annually in the US alone, suggesting a significant market potential for the new invention.
The innovations produced by the Biodesign program participants are commercialized by Yissum, the university’s technology transfer company of the Hebrew University of Jerusalem, and Hadasit, Hadassah’s technology transfer company.
DELIVERING MEDICAL TEST RESULTS
The results of common medical tests are sometimes delivered to patients by email, letters or voicemail, but are these the most preferred methods? According to one of the first studies to look at this question, the answer is no.
The survey by researchers at Georgetown University Medical Center, recently published in the Journal of the American Board of Family Medicine, found that while speaking face-toface may be optimal, a large number of participants also feel comfortable receiving a variety of test results electronically.
For receiving results of common tests such as blood cholesterol levels, the survey of 409 participants suggests that password-protected web portals are preferred, and participants are also largely comfortable with alternate communication methods including email, texts or voicemail.
However, that is not the case for two very sensitive tests: non-HIV sexually transmitted infections (STIs) and genetic test results. In those cases, most would strongly prefer to receive the results only via a password- protected patient portal/website.
“Communication with patients may need to be on a case-by-case basis; every individual may have a personal preference, and there may be a way to indicate those preferences in the patient’s record. The goal of this study was to try to better understand these preferences, so we can improve doctor-patient communication,” said the study’s lead researcher, Prof. Jeannine LaRocque.
It is not rare for a physician to call or email a patient with results to common tests without any idea of which is preferred in different contexts, but “this study makes clear that in some cases the majority of people prefer something different than what we’ve been doing,” added researcher Dr. Daniel Merenstein.
The survey tested the desirability of seven different non-in-person communication methods for receiving three different kinds of tests: common tests such as blood cholesterol and colonoscopy results; non-HIV STIs, and genetic testing (predisposition to a disorder, carrier of an inherited gene linked to a disease and a carrier of a genetic disorder).
The seven methods of communications surveyed were a password-protected patient portal website; cellphone voicemail; personal email; letter; home voicemail; fax and mobile phone text. Researchers found that in all categories, patients are least comfortable receiving information via fax.
Half or more prefer receiving cholesterol or colonoscopy results in four ways – password-protected patient portal websites, personal voicemail, personal email or letter. The majority did not want to receive a home voicemail message, mobile text message or fax.
For receiving results of STIs, only one method was preferred by the majority of participants: password- protected websites. No single method was preferred for genetic test results; the closest, at 46 percent, was also password-protected websites.
“With highly sensitive medical results such as genetic test results, patients may not trust the privacy of methods such as personal voicemail or email, whereas password- protected websites provide an added level of security, which may be necessary as these tests become more prevalent in primary care practices,” LaRocque said.