Many common surgical procedures now are faster and less painful thanks to new, minimally invasive techniques.

By Yasmine Iqbal

Years ago, having any kind of surgery was an ordeal: A long hospital stay, significant pain, large scars, and a prolonged recovery were the norm. But advances in medical technology and techniques, as well as anesthesia and pain medications, have made many common surgeries safer, faster, and less painful than ever before. ■ Going “under the knife” is never pleasant, but the stories of four military men — who each had a different procedure, and who each found the experience much less traumatic than he expected — illustrate just how far minimally invasive surgery has come.

Knee replacement

For years, Ed Dean, who served in the Navy as a machinist during the Korean War, coped with worsening arthritis in his knees by trying every over-the-counter remedy he could find, from muscle rubs to dietary supplements.

Dean finally sought medical intervention with cortisone shots, which provided some relief. “But then, the pain came back twice as bad,” he says. Still, he avoided surgery, especially after hearing about friends’ painful knee replacement procedures. By 2005, however, he was barely able to walk, and he realized surgery could be his only option.

Dean’s search for a surgeon who could get him back on his feet as soon as possible led him to Dr. Jess Lonner, director of Minimally Invasive Knee Surgery at Pennsylvania Hospital in Philadelphia.

In May 2005, Lonner performed a bilateral total knee replacement, giving Dean two new knees in one surgical procedure.

As in traditional surgery, Lonner replaced the arthritic ends of Dean’s thigh and shinbones with prosthetic caps. The difference is how he did it — instead of making one long cut, he worked through an incision only a few inches long using an arthroscope, a telescopic device that allowed him to view a magnified image of the knee joint on a video screen. He also spared the quadriceps tendons and muscles, which are cut in traditional procedures. It’s the healing of the muscle and tendon that causes much of the pain of recuperation, and leaving them intact allows for less blood loss and a faster recovery.

To his surprise, Dean found he could stand unassisted within hours after surgery, and the next day he was walking without crutches. Because of an unusual reaction to the anesthesia, he stayed in the hospital for a week to recover. “During all that time, however, I had no pain in my knees, apart from some discomfort from the surgical staples,” he says.

Dean went through two months of physical therapy; after about a month, all that remained of his once-excruciating pain was some minor stiffness. “I’m 73, but I can keep up with a 40-year-old,” he says. “My only regret is that I didn’t have this done earlier.”

Prostate surgery

For 14 years, Kenneth Klocek, a retired Navy captain, took medication to treat the symptoms of benign prostatic hyperplasia (BPH), which affects almost half of all men over age 50. BPH causes the prostate to enlarge and put pressure on the urethra, resulting in difficulty urinating or a constant need to urinate.

Gradually, the medications lost their effectiveness, so Klocek sought help from Dr. Tim Donahue, a urologist at the National Naval Medical Center in Bethesda, Md. Klocek assumed he would have the standard procedure for BPH, a transurethral resection of the prostate, or TURP, in which excess prostate tissue is cut away.

But Donahue offered him another option: GreenLight laser surgery, which involves inserting a thin fiber-optic probe through the urethra and into the prostate while the patient is under general or spinal anesthesia. The probe delivers targeted laser energy that gently and precisely vaporizes excess tissue, relieving the pressure around the urethra and reestablishing normal urine flow.

“The GreenLight does the exact same thing as a TURP procedure, with less blood loss, less tissue damage, and a faster recovery time,” says Donahue. “Almost anyone with BPH would be eligible — if you can have a TURP, you can have the GreenLight procedure.”

At first, Klocek was hesitant, but online research helped convince him to have it done in June 2005. The experience wasn’t pain-free — he spent one night in the hospital, and it took about a week before he could urinate without pain. But he was able to stop taking BPH medication immediately, and today, he’s symptom-free.

“Don’t delay, and don’t be bashful about visiting your urologist,” Klocek advises men who are suffering from BPH symptoms. “I’d have the procedure done again, and I wish I’d had it done sooner.”

Cataract surgery

Dee Wayne Burrows, a retired Navy pilot, had his first cataract procedure 15 years ago at the National Naval Medical Center. As was common then, his surgeon removed the cataract in one piece through an 11-millimeter incision in his eyeball, inserted an artificial lens, and closed the incision with sutures during a 45-minute procedure. Burrows remembers the experience as painless, and he left the hospital the same day with an eye patch. He could see just fine the next day — certainly an improvement from years earlier, when cataract patients had to stay in the hospital for weeks while their incisions healed.

Last year, at age 60, Burrows returned to Bethesda Naval to have the procedure on his left eye. But by then, the technology used to remove cataracts (which occur when the eye’s natural lens becomes cloudy) and the artificial lenses themselves had vastly improved.

Burrows’ ophthalmologist, Dr. Kerry Hunt, anesthetized the eye and made an incision only 4 millimeters long. He then inserted a tiny probe that emitted high-frequency sound waves that broke up the cataract and then sucked up the fragments — a technique called phacoemulsification. After that, he inserted a replacement lens that was custom-fitted for Burrows’ eye. The natural pressure inside the eye closed the incision, obviating the need for stitches, and the procedure was over in 15 minutes.

Burrows, who was awake throughout the surgery, noticed a difference in his vision right away. “It was like someone came into the room and turned on all the lights,” he says. He left the hospital in about an hour with a clear eye protector — no patch required.

Today, Burrows has almost regained the near-perfect vision he once had. “I don’t wear glasses to drive or participate in one of my favorite pastimes — umpiring baseball,” he says. “Everything is brighter — I’d had no idea that everything was dark before.” Hunt says this is a common reaction. “People don’t realize how much vision they’re losing as their cataracts get worse,” he says. “When they have the procedure, they’re amazed at how much they get back.”

Gallbladder removal

Michael O’Connor never expected to find himself facing emergency surgery, especially the day after completing a Navy physical fitness test. Nevertheless, last October, sudden, severe abdominal pains caused the 40-year-old Navy captain to be rushed to Mercy Hospital in Pittsburgh, where he was diagnosed with gallstones — small, hard deposits of cholesterol and salts that had formed in his gallbladder, a pear-shaped organ below the liver that stores bile. To correct the problem, his gallbladder would have to be removed.

It was the first time O’Connor would have any kind of surgery, but he wasn’t unfamiliar with gallbladder removal, also called cholecystectomy. Gallstones ran in his family, and he had relatives who still bore large scars from the procedure.

O’Connor, however, had a minimally invasive gallbladder surgery. The surgeon used a laparoscope (similar to the arthroscope used in knee surgery) to view the internal organs, and he removed the gallbladder through four small incisions, the longest of which was 3⁄4 inches. Instead of stitches, a surgical superglue was used to close the wounds.

What surprised O’Connor most was the lack of pain after the 90-minute procedure. “I had some grogginess from the anesthesia, but apart from a few Tylenol, I didn’t need any pain medication,” he says. He left the hospital after a few days, and his incisions quickly healed as the surgical glue dissolved.

Within about a week, O’Connor returned to work, even commuting back and forth on his bicycle. He had some difficulty adjusting to dietary changes; because he can no longer store bile, which helps digest fats, he’s had to cut down on fatty foods and include more fiber in his diet. But overall, he says the experience was a “walk in the park.”

With all these advances, surgery should never be taken lightly. All procedures carry some risk, and experiences with postoperative pain vary widely. Klocek had some pain for a week after his GreenLight surgery; he says a friend who had the same procedure left the hospital the same day and was playing tennis within a week.

If you’re having elective surgery, take a cue from Klocek and Dean — both men researched their procedures and knew exactly what they were getting into; Dean even checked the infection rates at various hospitals. Check your surgeon’s background and level of experience as well. Becoming an expert in minimally invasive techniques takes time and practice, and the more procedures your surgeon has done, the better your chances of a positive outcome.