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Gallbladders can be removed via navel

The lowly belly button is no longer just a useless dent in the body. It's now the portal to the gallbladder. Surgeons are rushing to be trained in a new form of cholecystectomy, or gallbladder removal, that involves pulling the diseased organ out of a small hole in the navel.

Only about one in five surgeons have received certification to perform the procedure, called a laparoscopic cholecystectomy. And even among those who have been trained, many have had little practice. So the patient who wants the procedure done needs to shop around.

But the effort is worth it. The laparoscopic cholecystectomy eliminates the traditional 6-to-10-inch scar, reduces the hospital stay drastically and gets the patient back to work in about a week rather than a month or two.

"The turnabout time is remarkable," said Tampa medical assistant Sherry Calero. "I had it done on Thursday afternoon, and went home (from the hospital) on Friday. . . . By Sunday I felt great."

Dr. Alexander Rosemurgy, associate professor of surgery at the University of South Florida, said, "Initially I was as skeptical as everyone else. But if I needed to have my gallbladder out _ God forbid _ that's how I'd have it done."

Dr. Barry Haicken of Largo, who has performed the new procedure 110 times since January and has written a book on it, says he thought the operation was a hoax when he went to Tennessee last November in the first group of U.S. surgeons to be trained.

"When I left Nashville I was a real believer," he said. The results were simply astounding.

"I've done over 2,000 gallbladders the traditional way _ a big incision, big scar, lots of pain. Now there's just four very small incisions. And people go home the same day or the next."

Complications have occurred only about one-third as often as with the open surgery, Haicken says. He has begun using it in some appendectomies, as well.

The gallbladder is a sack that sits under the liver and ranges from the size of an adult thumb to a large grapefruit. It stores bile, a waste product that pours into the intestine to aid digestion of fats. Gallstones often form and block the tube that carries the bile from the liver to the duodenum, causing excruciating pain and infection.

In a laparoscopic cholecystectomy, the surgeon makes four quarter- to half-inch incisions in the abdomen and inserts steel or vinyl sleeves. Through one passes a camera with a powerful light source that will show whether there is any disease in the belly; through another, carbon dioxide is pumped in so the organs can be easily seen and manipulated.

Using long-handled instruments, the surgeon grabs the gallbladder and cuts or laser-burns it free. Next, the surgeon brings the organ to the surface, punctures it, suctions out the bile and crushes the largest gallstones. The deflated gallbladder can be pulled out through the incision in the navel.

Most of the half-million gallbladders taken out of American abdomens this year will be done the traditional way. Few surgeons were doing the procedure until a few months ago, and manufacturers are still scrambling to provide the sophisticated instruments to all the hospitals that want them.

But surgeons qualified to perform the procedure are no longer scarce. If you need to find one, take these steps:

Ask your family doctor for a referral.

Find out whether the surgeon is certified by the American Board of Surgery and certified to do the laparoscopic cholecystectomy.

Ask how many times the surgeon has done the procedure and what the results were.

Ask to speak to a patient who has undergone the procedure.

Fla. doctors' earnings high

Florida doctors are the richest among those in the 10 major states, according to the Sept. 3 issue of Medical Economics.

For 1989, Florida doctors reported a median gross income of $282,500 and a median net income of just under $158,000, the magazine reported. This was an increase over the year before of more than 28 percent.

Next highest in income were California doctors, who grossed $250,000 and netted just under $141,000. Their yearly increase was 16 percent.

Next was New York, followed by New Jersey, Pennsylvania, Texas, Illinois, Michigan, Virginia and Ohio. Ohio doctors grossed $243,000 and netted $123,000.

The average earnings of some specialists among all the states can be eye-popping.

Cardiovascular surgeons rule the roost, with a gross income of more than a half-million dollars and a net of $360,000. Neurosurgeons come next, netting $272,000, then orthopedic surgeons at $239,000, plastic surgeons at $221,000, thoracic surgeons at $209,000 and OB-GYNs at $205,000.

At the other end of the income scale are the non-surgeons: general practitioners at $102,000, family practitioners at $106,500, pediatricians $111,000, psychiatrists $112,500 and internists $122,000.

Smoking and cervical cancer linked

Smoking and sex are a popular combination. But together, new research suggests, they can be deadly for women.

A study of 60 women with advanced cervical cancer shows that 85 percent were smokers, and the rest had significant exposure to smoking, generally because their husbands smoked. The study, done at Montefiore Medical Center in New York, provides the strongest evidence yet of a connection between smoking and cervical cancer.

"Cervical cancer and abnormal Pap tests are clearly related to smoking and that deserves major headlines," Dr. Carolyn D. Runowicz, who wrote the study, told the New York Times.

"In old movies you see Lauren Bacall drawing on a cigarette in bed after sex, looking glamorous and sophisticated," she said. "That's the image I'm fighting.

"If you're going to have sexual intercourse, not only should you use condoms, but also you shouldn't light up."

Cervical cancer strikes 13,500 American women and kills 6,000 every year, according to the American Cancer Society.

C-sections at Florida hospitals

Last week's column, which discussed the high rates of Caesarean sections among American women (particularly those with insurance), was supposed to be accompanied by a chart showing the C-section rates at various Tampa Bay hospitals.

We had more news than space that day, however, so the chart got squeezed out. Since many of you have asked for that information, we're running it today.

1989 C-section rates

All Commercial

Patients Insurance

CITRUS

Citrus Memorial Hospital 23% 31%

HERNANDO

Lykes Memorial Hospital 29% 37%

PASCO

E. Pasco Medical Center 30% 25%

Riverside Hospital 36% 39%

Humana Hospital 27% 28%

PINELLAS

Morton F. Plant Hospital 21% 23%

Sun Coast Hospital 26% 25%

Bayfront Medical Center 27% 33%

Women's Medical Center 27% 26%

Mease Hospital & Clinics 34% 34%

St. Anthony's Hospital 41% 50%

HILLSBOROUGH

Tampa General Hospital 16% 24%

S. Florida Baptist Hospital 25% 31%

Humana Hospital, Brandon 31% 32%

Humana Women's Hospital,

Tampa 35% 36%

STATEWIDE 27% 32%

Source: Jay Cushman, Health Planning & Development, Portland, Ore.

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