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OneThousandOne represents the amount of time, verbally, that it takes to count to one second. In this one second of time, a great thing happened at The Nebraska Medical Center. In fact, several great things probably happened. A patient was cured, a researcher found the missing link, a nurse treated an injury, a doctor comforted a family or maybe a child just smiled.
MOMENTS IN MEDICINE at THE NEBRASKA MEDICAL CENTER
Spring | Summer 2009

No Small Innovation

Sherri Mastin enjoys a lunch at her favorite
restaurant, La Mesa in Papillion

After a year of suffering persistent and worsening symptoms of reflux, Sherri Mastin’s quality of life had taken a dramatic spiral downward. “I was constantly in pain,” recalls Mastin, of Papillion, Neb. “I had constant reflux, nausea and a stabbing pain that traveled up my back to my shoulders. Every time I ate, the symptoms started up again and would continue throughout the day.”

As the symptoms worsened, they began waking Mastin up at night. When over-the-counter antacids didn’t work, Mastin went to her doctor and tried several prescription medications, with still no relief.

A referral to laparoscopic surgeon and esophageal specialist Dmitry Oleynikov, MD, of The Nebraska Medical Center, lead to testing that revealed Mastin had reflux disease with a hiatal hernia and needed surgery fast. Her stomach was protruding through her diaphragm and up into her chest. In individuals with hiatal hernias, the hiatus – the opening of the esophagus where food empties into the stomach – sometimes becomes weakened or enlarged, allowing acidic digestive juices to pass up into the esophagus. Part of the stomach may also slip up or pass (herniates) through the hiatus and into the chest.

“If left untreated, hiatal hernias can cause the blood supply to the stomach to be cut off and can be fatal,” says Dr. Oleynikov, one of the country’s leading experts in advanced minimally invasive surgery. Dr. Oleynikov performed a minimally invasive hiatal hernia technique in combination with an anti-reflux surgery called Nissen fundoplication to correct Mastin’s condition.

Because both procedures were done with minimally invasive techniques, also referred to as laparoscopic surgery, they required just several small incisions that were closed with only a few stitches. Laparoscopic surgery uses miniature cameras with microscopes, tiny fiber optic lights and high definition monitors that allow surgeons to perform specialized techniques to correct many problems without requiring the patient to undergo major surgery or large incisions.

The hiatal hernia and Nissen fundoplication procedures are among a growing list of minimally invasive procedures developed and/or perfected by Dr. Oleynikov, who has performed thousands of minimally invasive procedures since he came to The Nebraska Medical Center in 2001. As a whole, his success rates are often three times better than the national average.    

As a whole, Dr. Oleynikov’s success rates are often three times better than the national average.

The hiatal surgery technique involves moving the herniated area of the stomach back into the abdominal cavity. He then tightens the esophageal hiatus, making it smaller so the stomach no longer bulges through. The esophagus is then firmly attached to the diaphragm and a mesh-like device is used to reinforce the area to prevent recurrence. The introduction of this device, which was developed by Dr. Oleynikov, has reduced the recurrent rate of this condition to 3.8 percent. This is compared to former procedures that experienced as much as a 40 percent recurrent rate.

The second part of the surgery – Nissen fundoplication – involves recreating an improved valve to prevent the escape of acids from the stomach into the esophagus. Dr. Oleynikov authored a study that demonstrated that this procedure can stop, and in some cases reverses, the progression of Barrett’s esophagus, a precursor to esophageal cancer, which is a common result of gastro esophageal reflux disease (GERD). Reflux and esophageal cancer are two of the most rapidly growing diseases in the country. It is estimated that more than 15 million people suffer from GERD.

Dmitry Oleynikov, MD

It’s been less than a year since Mastin had the surgery performed and she says she is feeling “100 percent” better. “I’m pain-free now,” says Mastin. “Dr. Oleynikov was great. I’ve already referred other friends to him.” Mastin no longer needs to take medications, and the only adjustments she has had to make since the surgery is to eat smaller meals and to eat more slowly.

Under Dr. Oleynikov’s leadership, The Nebraska Medical Center has become one of the nation’s leaders in pioneering new and innovative minimally invasive surgical procedures that are making surgery less demanding and more comfortable to the patient.

“If a procedure can be done laparoscopically, it’s being done 95 percent of the time in this institution,” says Dr. Oleynikov. “We are more aggressive at using laparoscopic surgery than most of the rest of the nation because of our culture, knowledge, technology and support by the institution. Is someone going to be doing something laparoscopically at the Mayo Clinic or Texas Medical Center that we aren’t already doing here? The answer is no. We are the leaders in this field.”

And for those who need surgical care, that’s good news. With numerous advantages such as smaller incisions, less preoperative time, shorter hospital stays, quicker return to normal activity, reduced risk of herniation or wound separation and reduction of potential complications – what’s not to like about minimally invasive surgery?

According to Dr. Oleynikov, recent advances in technology have led to a dramatic increase in the ability to treat a variety of conditions using minimally invasive procedures. These procedures are just as effective and sometimes more effective than traditional surgery because they carry less risk of complications and quicker healing times.

As many as 50 percent of traditional surgeries are now performed with minimally invasive techniques, says Dr. Oleynikov. These range from the more common procedures like gallbladder removal, anti-reflux surgery and hernia repairs to the very complicated such as removal of the esophagus, colon and other internal organs as well as repair of diaphragm defects and weight loss surgery cases.

The Nebraska Medical Center is
one of the nation's leaders in the
use of robotic surgery.

In many cases, minimally invasive procedures have been pioneered or perfected at The Nebraska Medical Center, says Dr. Oleynikov. In addition to hiatal hernia repair and Nissen fundoplication, other procedures having the medical center physicians’ imprint on them include colon removal and weight loss surgery techniques such as Roux-En-Y gastric bypass and gastric banding bypass. “Our doctors have published papers about how to perfect these procedures and make them safer for our patients,” says Dr. Oleynikov. “Centers around the country have changed how they perform these procedures based on our findings.”

Training in advanced minimally invasive techniques has also improved. Many surgeons complete an advanced laparoscopic training fellowship after their surgical training. Certification courses are also available to practicing surgeons. Physicians at The Nebraska Medical Center are required to complete advanced training before they can perform minimally invasive procedures. In addition to a busy surgery schedule, Dr. Oleynikov also speaks at medical conferences across the country and teaches six courses a year on advanced laparoscopic surgery to medical residents and medical staff at the University of Nebraska Medical Center.

Dr. Oleynikov is currently working on perfecting one of the newest and most innovative minimally invasive techniques that involves removing organs through natural body openings such as the mouth or vagina. Called natural orifice translumenal endoscopic surgery (NOTES), the technique takes the concept of minimally invasive surgery to the next level by further reducing pain and recovery times and leaving no visible scars. Currently, a handful of medical centers across the country are performing the experimental procedure with fairly good success. The procedure can be used in procedures that involve removing anything within the abdominal cavity. For instance, a surgeon at the University of California San Diego Medical Center successfully removed a woman’s gallbladder through her vagina while another center removed a kidney. Other centers have removed an appendix and a gallbladder through the mouth.

“Centers around the country have changed how they perform these procedures based on our findings.”
Dmitry Oleynikov, Md

However, Dr. Oleynikov says there is work to be done in perfecting the technique and in the instruments used before the procedure will be offered at The Nebraska Medical Center. “We won’t offer the procedure until we know we can do it prudently,” he says. Dr. Oleynikov is currently working on a miniature robotic device that he believes will improve the procedure. The device would be run by remote control and be equipped with a camera and tiny instruments that would be more precise than an endoscope – the device that most surgeons currently use to look inside the body.

“I expect we’ll be performing the procedure here within the next five years,” he says.

Greater use of robotics is another area of minimally invasive surgery that Dr. Oleynikov is working to advance. “The Nebraska Medical Center is one of the nation’s leaders in the use of robotic surgery,” he says. The medical center has been performing robotics since 2000. The technology is being used aggressively by all specialists at The Nebraska Medical Center in those cases that can benefit from the extra precision provided by robotics. “At most hospitals, the use of robotics is limited to primarily urologists,” says Dr. Oleynikov, “but that is not the case here.”

Dr. Oleynikov says he is refining the development of miniature robotic devices with tiny arms that can be swallowed. The surgeon would then perform the procedure with the use of remote control. “We are developing prototypes and currently doing experiments on lab animals,” says Dr. Oleynikov. “As we get better and more flexible robots, we’ll see robotics being used more, and I expect The Nebraska Medical Center to be on the leading edge of this technology.”

In the meantime, Dr. Oleynikov will continue to provide safer and more patient-friendly procedures to patients like Sherri Mastin. Just a few small scars on her abdomen are the only reminders of the life-saving procedure she underwent less than a year ago. “What he did was amazing,” she says. “Within a week I was up and going and now I can actually enjoy eating again.”

Previous article in the Spring | Summer 2009 issue of One Thousand And One:
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