What is Bloodless Surgery?
‘Bloodless surgery’ term or technique was invented by the most famous orthopedic surgeon of Vienna, Adolf Lorenz. He used non-invasive methods to treat his patients. He was hypersensitive to carbolic acid which was used in operating rooms which later forced him to become a “dry surgeon”.
Bloodless surgery involves both invasive and non-invasive medical techniques and protocols, but the blood loss is less or nil during the procedure. Some bloodless techniques do not need blood transfusions i.e. it is performed without transfusion of allogeneic blood.
Am I a Candidate for Bloodless surgery?
If the patient’s specific procedure or surgery ‘may need/ needs’ blood conservation technique, then he/she is the ideal candidate for bloodless surgery.
Techniques and Methods Used in Bloodless surgery
Before, during and after surgery:
The techniques or methods have significantly shown positive results in health which are approved by the FDA. (These are strictly not experimental)
1. Minimally invasive surgery technique may be used to avoid major blood loss.
2. Laser or sonic scalpels for tumor destruction
3. Electro-surgery and electro-cautery
4. Low central venous pressure anesthesia
5. Suture ligation of vessels
6. Blood substitutes like Polyheme which carry oxygen is made from hemoglobin will be used in place of blood.
7. A heart – lung machine is used for blood circulation, which is also known as Extra Corporeal Circulation of blood.
8. The Beating Heart Surgery technique to stop bleeding after surgery.
9. Cell saver machine collects and returns blood, in short, maintains a close circulation loop without storing.
10. Surgical pads and gauze to absorb a notable quantity of blood.
11. Intraoperative Hemodilution is a blood conservation technique.
12. Intraoperative blood salvage for recycling blood.
13. Cyberknife and Gamma knife radiation therapy for oncology
14. Endoscopy for removing pituitary tumors.
15. Laparoscopy or keyhole surgery using surgical laser, Argon Beam Correlation (APC), harmonic scalpel and Ultrasonic Surgical Aspirator
16. Phacomulsification for cataract surgery, where not a single blood vessel is touched.
17. Phanonit and micro-phaconit for tiny incision in eye.
18. LASIK, Intraocular Lens and Femtosecond Assisted Lamellar Keratoplasty are bloodless procedures.
19. Robotic surgery, which involves lesser incisions.
20. Hypotensive anesthesia for lowering the blood pressure.
21. Haemodilution for diluting blood at the beginning of surgery.
22. Selective Embolization/Embolotherapy.
23. Certain Patient Position like Trendelenburg position decreases the amount of bleeding.
24. Certain Anesthesia Techniques.
25. Cryosurgery.
26. Apheresis i.e. donating own platelets and plasma
Before surgery:
• Induced Hypothermia is a technique that slows down metabolism in the anemic patients, therefore oxygen demand is reduced.
• Hyperbaric Oxygen therapy controls and increase the oxygen content in anemic patients.
• For the less volume of a blood sample, the tiny pediatric tube is used. It is also known as blood sparing technique.
After surgery:
• Self-transfusion drainage to recover post-operative blood drainage
• Use erythropoietin injections to increase blood volumes
Major Treatments done using Bloodless surgery
- Lung Transplants: This bloodless surgery involves a surgical technique done in a précised manner, acute normovolemic hemodilution, cell salvage and low prime cardiopulmonary bypass circuits.
- Liver Transplants: The diseased liver is replaced with a healthy liver in transplantation surgery. In bloodless surgery, the methods like blood salvage, plateletpheresis and autotransfusion are used. Erythropoietin, which is a glycoprotein hormone increase the production of red blood cells, therefore no blood transfusion is needed. Some human blood products are withheld, in which albumin is an exception. After allograft reperfusion, plateletpheresis and platelet-rich plasma is utilized. There is no possibility of morbidity or mortality using blood conservation techniques. There are cases that patients are still alive for 3 years, after the orthotopic liver transplantation.
- Pancreatic surgery: Bloodless Whipple operation or laparoscopic procedure to remove cystic tumors or cancer is done.
- Gynecological Surgery: For minimal blood loss, laparoscopic and robotic techniques are associated with bloodless surgery.
- Vascular Surgery: Bloodless vascular surgery involves minimal incisions in the side of the chest causing lesser blood loss.
- General Surgery: Surgeon uses specialized instruments and techniques for general surgery.
- Obstetrical Care: Bloodless medicines for mother and pediatric patients.
- Urologic Surgery: Robotic surgery is done to treat Urologic cancers.
- Cancer Surgery: Robotic, minimal invasive or radiation techniques to remove or shrink the tumor.
- Open Heart Surgery: With Bloodless Open Heart Surgery there is a significant lower rate of myocardial infarction and bleeding. Acute normovolemic hemodilution is performed to remove and store several units of blood in the operating room just before surgery. Blood conservation practice lowers morbidity. Blood-sparing technique is effective and safe that results in lower mortality and morbidity rates. The bloodless surgery for Ruptured heart valve, single bypass, coronary artery bypass graft surgery etc. are done till now. It is more preferred because the risk associated with blood transfusions is low. The patient has shorter hospital stays and it is very effective for infants and children.
- Stereotactic Neurosurgery: Radiation techniques like Cyberknife or gamma knife are used to remove or shrink the tumor. There is no need of anesthesia because the system is controlled by computer.
- Orthopedic Surgery: Shoulder, elbow, hip, knee, ankle and wrist repair is done using an arthroscope which minimizes blood loss. Before surgery patients are evaluated for anemia. If it is less then Procrit, iron, and vitamin B12 is given to lessen the effects. Cell salvage procedure is used to save and recycle the blood. Tourniquet, Tranexamic acid and fibrin sealants are used to minimize blood loss. The surgeon may use an intravenous Tranexamic acid to minimize the intraoperative and postoperative blood loss during total hip and knee replacement arthroplasty, partial knee replacement, knee arthritis treatment and revision hip and knee surgeries. This procedure minimizes the chances of blood transfusion. Intraoperative meticulous technique works effectively and safely to minimize blood loss. Cell salvage is a method to capture patient’s blood and circulate back during the surgery. Conservative treatment may include anti-inflammatory medications, injections and physical therapy.
- Neonatal and Pediatric Surgery: Controlled hypotensive anesthesia, minimal invasive technique and bloodless medicines for pediatric surgery.
- Pediatric Cancer Treatment: Various radiation techniques like Cyberknife or gamma knife are used to remove or shrink the tumor. There is no need of anesthesia because the system is controlled by computer.
- Cardiology: Various surgical, anesthetic and pharmacological techniques minimize blood loss during cardiac surgery. Cardiologists perform various routine tests such as Echocardiogram, Cardiac MRI, Exercise echocardiogram and Cardiac catheterization. Pediatric sized laboratory tubes are used to collect blood for certain tests. Cell salvage method captures the patient’s blood and circulates back during surgery. Erythropoietin, iron and vitamins are given to the anemic patient before the operation. The risk of bleeding can be reduced with cardiac catheterization procedures. Placing of sheath in the groin region’s femoral artery or in radial artery of the wrist can minimize blood loss. Even certain pharmacological agents help in reducing intraoperative blood loss.
- Otolaryngology: Electrocautery/Electrosurgery has remained the main surgical instrument for most of the surgeons. Hemostatic surgical instruments reduce bleeding & tissue handling.
- Urologic Surgery: For bloodless Urologic surgery various methods like robotic, laser and other minimally invasive techniques are used for minimal blood loss.
- Plastic and Reconstructive Surgery: In Plastic surgery, the methods used are Electrocautery & harmonic scalpel devices, suture ligation of blood vessels, surgical clips, and vasoconstrictive agents are used to minimize blood loss.
- Kidney Transplant: Surgeons make use of minimally invasive technique or laparoscopic nephrectomy for kidney transplantation. In bloodless surgery, methods like blood salvage & blood conservation techniques and auto-transfusion are used. The advantage of bloodless surgery is: it doesn’t require any special equipment, has less adverse effects, reduced immunosuppression, less infection rates, shorter hospital stay and faster recovery time.
Neurosurgery:
Bloodless Neuro surgery treats:
• Congenital diseases of the brain and spine
• Tumors in brain, spine and spinal cord
• Aneurysms and vascular malformations which are deadly vascular diseases
• Degenerative disc and other spinal diseases
• The spine and cranio-vertebral junction arrangement
• Pituitary gland diseases
• Epilepsy or movement disorders
• Brain stroke and hemorrhage
• Hemorrhage in spinal cord
• Various injuries and tumors of the peripheral nerves
• Trigeminal neuralgia pain
Bloodless techniques like Cyberknife, gamma knife, X-Knife are precise, non-invasive, painless & bloodless neurosurgery techniques used to remove or shrink the tumor. There is no need of anesthesia because the system is controlled by computer. It is performed on an outpatient basis. The complex brain and spine surgery is performed with the keyhole procedures. The advantages are minimal pain & blood loss, lesser healing time of wounds and quick recovery.
Bloodless surgery for Jehovah’s witnesses:
Jehovah’s Witnesses believe in ‘not accepting blood transfusions or donating or storing’ their ‘own blood or its primary components’ for transfusion. They are the followers of the script which is written or mentioned in one of their doctrines. They believe that removed blood is unclean, so it should not be accepted.
Jehovah’s witnesses who refuse blood transfusion or were afraid of contracting diseases through blood like AIDS, hepatitis, infections and immune system reactions can now feel relieved with the bloodless surgical procedures.
In recent years, some bloodless surgery experts have introduced numerous bloodless techniques to these patients. The techniques are beneficial for major surgeries such as open-heart surgery, total hip replacements, orthopedic surgery or brain/spine tumor surgery because it involves minimal blood loss during the procedure.
The permitted procedures or acceptable products by Jehovah’s witnesses are:
• Hemodilution
• Intraoperative blood salvage
• Heart-Lung Machine
• Dialysis
• Epidural Blood Patch
• Plasmapheresis
• Platelet Gel
• nonblood replacement fluids
• Hemoglobin
• Interferons
• Interleukins
• Platelet factor 4
• Albumin
• Globulins
• Cryoprecipitate
• Cryosupernatant
• Clotting factors like Factor VIII and Factor IX
• Erythropoietin
• PolyHeme
• Hemopure
Bloodless Surgery Centers in India
Bloodless surgery is practiced in various hospitals across the nation. India has maintained an international quality standard when it comes to blood banking or its managing. The bloodless surgery procedure is an alternative to the blood transfusions and even for certain blood borne infections. Those who hold fear of getting infected via transfusion, or people belonging to Jehovah’s Witnesses, for them minimally invasive surgical options are available in various countries. These centers are fully loaded with essential and cutting edge technologies such as advanced anesthetic equipments & cell saver systems which help surgeons in performing successful Bloodless surgery. the surgeons are highly qualified and have years of experience in performing bloodless surgeries in India & Abroad. Their procedures involve minimal incision or no incision techniques (radiosurgery) in which there is a reduced risk of blood loss in larger amount. The specialists in India make use of medicines or vitamins to increase the blood volume in the body after the surgery. Hence, there is no requirement of blood transfusion in many cases. Since 10-15 years, many bloodless organ transplant surgeries have been performed in India at affordable rates.
Benefits of Bloodless Surgery in India
The benefits of the bloodless surgery are:
• Minimal blood loss
• Advantageous for those who do not accept blood transfusions like Jehovah’s witnesses.
• Minimal scarring
• Peace of mind and faster recovery
• Lesser duration of hospital stay
• Negligible infections
• No allergies or contamination from blood
• Research has shown that people who undergo this surgery have quite few heart attacks and strokes compared to those who receive blood transfusions
• Very effective in organ transplant
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