With Mr Michael Johnston
Around the year 1000 AD, an Arabian surgical pioneer named Albucasis performed the first recorded open abdominal surgery, using ant-nippers and a thin suture pulled from an animal’s gut to sew the intestine shut.
A thousand years later, surgeons around the globe can cut, stitch and extract suffering bowels from across the room, with nothing more than an LED screen for vision, a joystick to control surgical tools, and a loudspeaker for communication.
Mr Michael Johnston is one of these modern intestinal surgeons. As a Colorectal Surgeon with St Vincent’s Private Hospital, he’s one of a team of surgeons dedicated to improving patient lives with new technology in the realm of intestinal disorders.
“In Victoria, St Vincent’s have been pioneers in the field of minimally invasive colorectal surgeries,” says Mr Johnston.
Minimally invasive colorectal surgery
Until about the turn of the century, patients requiring surgery of the bowel could be in for a 40cm-long incision across the abdomen, a week in a hospital ward, at least six weeks of home-bound recovery, a week-long fast, and a glorious, glistening pink scar for life.
Enter, a new generation of operations: minimally invasive surgeries. Where your bowel’s concerned, minimally invasive colorectal surgeries come in three types: Endoscopic operations pass a telescope containing a camera and operating instruments through the anus to remove tumours from the rectum. Colonoscope surgeries (also through the anus) use a long, flexible device to inspect and remove benign polyps. And finally, laparoscopic (keyhole) operations use cameras and tools passed through tiny incisions in the abdomen to remove or repair pieces of the intestine—either by hand or robotically (through a separate console).
Endoscopic procedures save patients from incisions in the abdomen, using the body’s natural openings as an entry point. In abdominal keyhole surgeries, what was once a 20-40cm incision (laparotomy) is now a cluster of 3-5 tiny holes for cameras and a 5-6cm hole for removing the offending elements. The effect of the smaller incisions on recovery times is drastic. A patient undergoing an operation for Crohn’s disease of the ileum can expect to be home 3-5 days after minimally invasive surgery, compared to 5-7 days with open surgery. A full recovery becomes three weeks, compared to the traditional six weeks.
And it’s not just smaller incisions and faster recovery times that minimally invasive techniques offer. Where patients previously needed stronger, opioid-based painkillers for the soreness of a 40cm incision, minimally invasive surgeries are a lot less painful, which means that patients can live out the recovery period with lighter, anti-inflammatory analgesics. Opioid painkillers are a known cause of constipation—not ideal post-surgery where the aim is to get things going as fast as possible. But anti-inflammatories don’t cause constipation, which means the gut can get back in action sooner.
Hospitals, too—with resources in well-publicised demand—benefit from shorter patient stays. Where patients now might need to wait two weeks or more to go in for abdominal surgery, halving patient stay times lets traffic flow, helping patients in need of surgery get in and out faster.
Drawbacks and limitations
“Occasionally, such as in difficult rectal operations, surgeries with obese patients, or in cases that involve major infection or bowel perforation, minimally invasive surgery may be potentially unsafe,” Mr Johnston notes. In these cases, surgeons will usually try hybrid options—performing half the procedure minimally and making, for example, a 15cm incision compared to a 40cm incision for the open part of the surgery. But with technology advancing and education increasing, the future’s looking bright for colorectal surgeries, even in the most difficult circumstances.
Mr Michael Johnston and St Vincent’s Private Hospital
Mr Michael Johnston is one of a team of Colorectal Surgeons who form the Melbourne Colorectal Specialists group. The team manage all colorectal conditions and have a keen interest in inflammatory bowel disease and colorectal cancer and have specialised training in laparoscopic colorectal surgery, Sacral Nerve Stimulation (SNS) for faecal incontinence and Transanal Endoscopic Microsurgery (TEMS). The team are also members of the Colorectal Surgical Society of Australia and New Zealand and members of the Section of Colorectal surgery of the Royal Australian College of Surgeons.
The Melbourne Colorectal Specialists consult and operate at St Vincent’s Private Hospital in Fitzroy. St Vincent’s has more experience in treating intestinal bowel diseases than any hospital in Melbourne. A pioneer in the field, the hospital has been using minimally invasive surgical techniques for colorectal surgeries for the past 15 years.
Mr Johnston consults primarily at:
St Vincent’s Private Hospital Melbourne
Level 3, Healy Wing
41 Victoria Parade
Fitzroy VIC 3065
Phone: (03) 9419 3377