by Robert Kimmel
Dr. Har Chi Lau does not hesitate when asked to identify what he considers as the foremost existing medical advance in his field. “Over the past decade, decade-and-a-half the greatest advance is the advent and progression of laparoscopic surgery and minimally invasive surgery,” he stated. Dr. Lau is a co-founder of the Minimally Invasive Center of Hudson Valley Surgical Group, located on the campus of Phelps Hospital.
Dr. Lau, and the Center’s co-founder Dr. Robert Raniolo, have been leaders in bringing minimally invasive surgery to Westchester, and particularly its use in hernia operations. They operate at both Phelps and St. John’s Riverside Hospital.
Traditional laparoscopic surgery differs from open surgery in that several very small incisions are made into which surgical tools are inserted to perform an operation. Patient recovery from laparoscopic surgery is most often faster than from open surgery and in-hospital time is reduced, or the procedure can be done on an out-patient basis, depending on the operation.
Improvements in the technique, along with better skill levels, have broadened its use for a variety of procedures, including single incision hernia operations, in which Dr. Lau has pioneered. Among the improvements within those surgical techniques, Dr. Lau describes are the tiny video cameras that allow surgeons to better observe their internal work on high resolution TV monitors and perform operations with more precision. Dr. Lau pioneered single incision hernia operations.
Dr. Richard Peress, Director of the Surgery Department at Phelps, concurred that minimally invasive, laparoscopic surgery constitutes the most significant advance in the field, “…pushing the envelope over the past decade in terms of what we can do.”
Another innovation in the minimally invasive surgical field is robotic surgery, whereby mechanical arms are controlled remotely by the hand movements of a surgeon at a console who views the work through a high definition 3D camera system. The daVinci robotic system in use makes a one small incision through which the operation is performed.
As an example, Dr. Peress said that with robotic surgery “…more surgeons have been drawn to our knee surgery center…and trained in the methodology because it offers more high tech and modern facilities.”
However, both Dr. Peress and Dr. Lau agree that a procedure, whether it is open, laparoscopic or minimally invasive robotic surgery, is not the solution for all surgical requirements, and as Dr. Lau put it, “…have a good conversation with surgeon, who should tell you, “One is better for you, one is not.”
Phelps’ new suite of operating rooms have been outfitted “…with a video system in which any images we capture, such as an MRI or X-ray, or a scope camera that is in the knee, or the patient’s vital signs, are stored on a computer…and with all the monitors, everybody in the room can keep abreast of what is going on,” Dr. Peres explained.
“Each of these technological quantum leaps are in the millions of dollars of investments, and they are investments in the quality of care, safety, and your reputation, and if you don’t have them, you fall behind and you are not offering or meeting the standard of care,” Dr. Peress stated.
The doctor sees “a lot of change in health care” driven by technology, regulations and economics.
“For a hospital to exist under the present regulatory climate, you have to have a lot of these other businesses that are supportive, whether it is transcriptions, IT, compliance checks, legal, accounting, verification, authorization services, that are outsources because a hospital can’t afford to maintain those services in house. That is what I call the parasitic industries that have developed that feed off of that effort, that support my care of a patient. which in turn is supported by a nurse,” Dr. Peress asserted.
“Different fees are paid to the hospital by different insurance carriers, by contract, including the federal government, Medicare and Medicaid, and some of them are below the cost to do the service.
So that is one of the challenges to running a hospital,” the doctor said. “I personally would not want to be the president or administrator of the hospital; it is a perpetual challenge.”