Houston surgeon pioneers new technology for abdominal operations

Imagine a fully inflated bag of microwave popcorn: This is how Dr. Brian Harkins’ abdomen during a laparoscopic operation.

Pumping carbon dioxide into the body is essential to providing surgeons with visibility during abdominal surgery, said Harkins, medical director of robotics, HCA Gulf Coast Division and practices at HCA Houston Healthcare Tomball.

Still, the pressure on the body can be tough, he said.

Since the introduction of laparoscopy, the standard carbon dioxide pressure has been 15 millimeters of mercury.

Harkins has long hoped to bring that number down – and now with the advancement of technology, his dream is becoming a reality.

“The less stress, the better,” he says.

A proponent of surgical advances

Harkins was a proponent of laparoscopic surgery before the technique became popular, and remembers the pushback when advocating the minimally invasive option in the early 1990s.

Because of this, Harkins was surprised to find himself on the other end of the spectrum when robotic surgery was first introduced.

“When you’re comfortable with something, you tend to push back everything new,” he said. “That was the case with me.”

Then, in 2014, Tom Jackson, then the CEO of Tomball Regional Medical Center, changed the surgeon’s mind.

“He’s a visionary,” said Harkins.

Jackson demonstrated the effectiveness of robotic surgery, and soon Harkins signed up for a training course.

“I was really there,” recalls Harkins. “I’ve changed gears completely.”

He was impressed with how much better patients got on with robotic surgery – and was excited about the possibilities the technology opened up.

“The robot gave me the opportunity to do even more minimally invasive surgeries,” he said. “Basically everything I’ve done has been converted to robots.”

Harkins was such a proponent of robotic surgery that he became a public speaker for the Intuitive Surgical Company. This led Harkins to a second connection – this time with CONMED, a company that also provides laparoscopic and robotic innovative medical solutions.

“As a consultant to the company, they showed me what they were working on and asked me what I thought of this or that – or what I thought was necessary,” he said.

The surgeon had a seat on the ring when CONMED developed and promoted its AirSeal technology.

“In the end, I saw the innovation up close,” he explained.

AirSeal launch

Basically, AirSeal stabilizes the presence of gas in the abdominal cavity. AirSeal was launched in 2012 and it circulates carbon dioxide in and out of the body so the pressure can be easily regulated.

And that was a game changer.

Previously, pressure could fluctuate or gas could leak, causing the surgeon’s work area to collapse and preventing organs and tissues from being visible, said Will Tillinghast, a spokesman for CONMED.

With AirSeal that was no longer a problem. The technology also opened the door to lowering pressure in laparoscopic procedures.

Initially, Tillinghast explained, the low pressure is limited to certain procedures and is mainly used by urologists and gynecologists. The earlier technology also required an additional incision. Recent advances in AirSeal create more options for a wide range of operations.

“This new technology enables general surgeons to take advantage of the benefits without additional incisions,” said Tillinghast.

After the US Food and Drug Administration approved the further development of AirSeal on August 19, Harkins was the first in the world to use the new technology.

The surgeon had previously used the original AirSeal platform.

“The gas blown into the abdomen has to stay there to allow visualization,” said Harkins. “AirSeal is a system that can be serviced and that is an important safety feature.”

Still, he wanted to remove the extra cut and lower the gas pressure.

“It would be less trauma to the abdomen,” he said. “And it would complement improved recovery after surgery. It would shorten the length of stay in the hospital. “

A pioneer with a new solution

The surgeon admitted he was shocked when he was offered to be the first to use the technology.

“There are a lot of great places out there,” said Harkins. “I was honored to be who you asked.”

Tomball isn’t exactly the first place that comes to mind in the medical world, he said with a smile. But HCA Houston Healthcare Tomball is an innovator in robotic surgery. In April, the hospital was accredited by the Surgical Review Corporation as a Center of Excellence in Robotic Surgery. The facility has also dedicated 30 percent of its operating rooms to robotic surgery.

The day after its approval, Harkins used the new AirSeal for three procedures – operations on a gallbladder, an inguinal hernia and an abdominal cavity. For all three, he completed the entire procedure at pressures of no more than 10 millimeters of mercury – a significant improvement, he said.

“That is a decrease of a third,” he said. “And it’s a big difference in patient outcomes. It was very helpful to have that.”

Tomball-based Patricia Arnold was one of the patients on Harkin’s first day with AirSeal for gallbladder surgery.

“I was told by other friends who had surgery that I would be in pain afterwards,” she said. “No, I haven’t. I haven’t had any problems and I feel great.”

After the procedure, she was able to walk and spend time with her daughter.

“DR. Harkins did a wonderful job,” she said.

Further progress in sight

Harkins wants all of its patients to benefit from shorter hospital stays, fewer complications, and better outcomes.

“DR. Harkins is a thought leader nationally and globally,” said Tillinghast. “He cares about everything, how do we bring patients home as soon as they are ready? And how do we care for them at the highest level?”

That was Harkins’ driver all along – that drove him to laparoscopic surgery and eventually robotics.

It’s also what makes him look for the latest and greatest medical solutions.

Harkins looks forward to increasing the use of AirSeal in general surgery – and discovering other tools that can help patients.

“That’s the goal – to be more efficient, less invasive, and get better results,” he said. “In my opinion we should all work towards it.”

Lindsay Peyton is a Houston-based freelance writer.