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Wednesday, February 24, 1999 Published at 17:04 GMT


Keyhole first for vascular surgeon

Kenneth Hall has a small scar after Mr David Nott's surgery

A Chelsea pensioner has made medical history by being the world's first person to undergo a groundbreaking operation on his arteries.

The technique in use - and Kenneth Hall's reaction
Dr David Nott used keyhole surgery to treat an abdominal aortic aneurysm, a life-threatening swelling of the body's main artery.

Conventional surgery leaves large scars and requires a long hospital stay, often including time in an expensive intensive care unit.

The new technique is much faster, halves recovery time and leaves less scarring. It also means the patient loses less blood.

It was first reported in Hospital Doctor newspaper.

Pioneering technique

Kenneth Hall, 73, was admitted to London's Chelsea and Westminster Hospital for treatment last week.

[ image: The keyhole requires an 8cm incision . . .]
The keyhole requires an 8cm incision . . .
He agreed to have the pioneering surgery under Mr Hall, who spent three years developing the technique.

It involves making an 8cm incision and a number of small ones for keyhole instruments as opposed to conventional operations, which involve making an incision five or six times as long.

To relieve the swelling, the surgeon sews in a graft - a plastic piece of tube.

Because the surgeon can see what is going on inside the patient using a laparoscopic camera, there is no need for a large incision.

[ image: . . . compared to up to 40cm with conventional surgery]
. . . compared to up to 40cm with conventional surgery
Although laparoscopes have been in use in general surgery for 10 years, this is the first time they have been used for vascular surgery.

Mr Hall told the BBC: "It's obvious the cosmetic benefits are great.

"You think of a massive scar down there, well, when you go out in the sun or something you don't want to see that sort of thing."

Use of the technique has the potential to cut costs and patient waiting times for surgery.

Mr Nott said: "Patient's may not need to go to the intensive care unit, which is extremely expensive.

"The beds situation is such that if you can keep patients out of intensive care units and relieve the pressure on those beds, then that is a significant advantage."

Mr David Rosin is a member of the Royal College of Surgeons council.

Further advances

He said Mr Nott's use of the technique was probably a world first, but it was not the least invasive form of surgery available for this condition.

Mr Nott's technique is to conventional surgery, but with a much smaller incision, he said.

But another technique - endoprothesis - minimises the incision further, meaning patients spend even less time in hospital.

Endoprothesis is currently being evaluated at five or six centres around the UK, he said.

This technique involves vascular surgeons working with radiologists. A graft is inserted to the artery near the groin and pushed up to where it is needed.

It is manoeuvred and expanded by X-ray control.

Less invasion

"This is the most minimally-invasive surgery available at the moment for this condition," Dr Rosin said.

Endoprothesis was the more likely candidate for long-term development, he added.

"Surgery is getting less and less invasive. Ten years ago there was no keyhole surgery, now it accounts for 50% of operations.

"Anything that means patients spend less time in hospital has got to be a good thing."

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