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Bloodless surgery comes to Duluth

While fear of surgery can be enough to make some patients procrastinate, a new approach may keep one unknown out of the operating room. With bloodless surgery, a traditional transfusion does not have to be part of the process. Getting blood from ...

While fear of surgery can be enough to make some patients procrastinate, a new approach may keep one unknown out of the operating room.

With bloodless surgery, a traditional transfusion does not have to be part of the process.

Getting blood from someone else to replace what is spilled during surgery raises headline issues: AIDS, hepatitis, West Nile Virus, a shortage of the right type blood or just getting the wrong type. There are also rising costs as the medical industry tries to provide blood that is absolutely safe.

Now that a growing medical movement has reached the Northland, patients for major procedures have an alternative. Bloodless surgery is a school of techniques to eliminate or minimize the need for a dose of someone else's blood by transfusion -- no small concern as a person considering a new hip or knee, weighs the risks, has personal convictions, or is just plain squeamish.

While blood types can be alike, a person's blood is uniquely his or her own. Research shows that a blood transfusion can suppress the immune system and increase a patient's chance of having a post-operative infection and longer hospital stay. For some types of cancer surgery, a blood transfusion has been linked to a higher rate of recurrence.

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Anesthesiologist Dr. Richard Banchs is behind the new Advanced Bloodless Surgery program at St. Mary's Medical Center in Duluth. A recent transplant from New York City, Banchs brings knowledge, experience and a passion for this medical development.

The program brings a new philosophy and a variety of techniques into the operating room that can reduce a patient's need for outside blood. He said the concept has been around for quite awhile, but many of the techniques used today are state-of-the-art.

While "bloodless surgery" is the accepted term, it might just as well be called "resource management," since it is an approach using the body's own reserves to achieve desired results.

"Bloodless really means surgery without blood from somebody else," Banchs said. "You act as your own reserve."

He described in layman's terms some methods used to reduce the need for outside blood during surgery.

A patient's red blood cells can be built up ahead of time, blood pressure can be lowered to reduce bleeding, lost blood can be recovered, clotting can be enhanced, blood can be diluted so a patient loses fewer red blood cells, and blood can be collected ahead of time for use during the procedure.

"It's really blood management," he said. "In the operating room, I can take one, two or three pints out of you and replace it with fluid. At the end of the surgery I give it back to you, instead of getting it from the blood bank."

"Any patient that comes to surgery deserves the opportunity that bloodless surgery affords in terms of education, in terms of care," he said. "So almost all the patients are candidates for bloodless surgery. But that does not mean that all the patients will get the same techniques."

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While the interesting work happens in the operating room, he said, bloodless surgery is actually a continuum of care -- a collaborative effort. It involves physicians in the community, specialists in the hospital, the surgeon and the assisting staff.

A former surgeon, Banchs said major surgeries involving head, chest, belly and legs will be the bulk of the bloodless procedures. He said any surgery that involves big bones, big joints, total hips, total knees -- surgeries where you are in the operating room a long and time and can have a large blood loss -- are best suited for bloodless techniques.

Patients can learn about bloodless surgery options from their physicians, specialists, the hospital or word-of-mouth.

Nobody is automatically ruled out," said Banchs. There are considerations for patients with certain heart problems, or certain diseases, such as severe sickle cell anemia. But even these patients can be candidates for some of the bloodless techniques.

"Part of this philosophy tries to use your own reserves to make you better prepared for surgery," he said. "Or to go through the process without using (donated) blood."

Banchs got into bloodless surgery when he was "soul searching," looking for other ways to help patients.

"Throughout my experience and my career, I realized that something else could be done for patients," he said. "I had mentorship of a couple of the pioneers in bloodless surgery in New Jersey, and that's how I got connected."

Though an advocate for bloodless, he said sometimes a transfusion is necessary and emphasized that the risk of getting contaminated blood is small. Banchs said there still is a vital need for donor-supported blood banks, and transfusions will remain part of emergency procedures when there is no time for alternatives.

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"But when there is time," Banchs said, "when the surgery is elective, when we can think about it and prepare you adequately, that is the time to harvest your own resources and to allow you to go through this process without needing blood from another person."

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