Urology and Bloodless Surgery: A Physician's Perspective
Allegheny General Hospital provides advanced treatment for kidney, prostate and bladder problems, as well as for other urological conditions. The Division of Urology is engaged in kidney transplantation and basic and clinical research, along with the use of new modalities for benign prostate hyperplasia (enlarged prostate).
Dr. Jeffrey Cohen is the director of Urology and has been in practice for the past 21 years. We recently interviewed Dr. Cohen regarding his treatment of patients who refuse transfusions.
You have successfully treated a number of patients who refuse transfusions. What interested you in being able to perform procedures, such as removal of the prostate, without the use of transfusions?
We want to achieve the best possible outcome for all of my patients. An outcome analysis of surgical procedures consistently demonstrates better outcomes for patients when you can decrease the length of surgery and when you can decrease blood loss. Therefore, we have made a conscious effort to limit bleeding in all of our cases – the result is less transfusions. The results, for surgery with the potential for blood loss such as radical prostatectomy, show a transfusion rate of under five percent.
For approximately 10 years, we have been treating member of the Jehovah’s Witnesses who decline transfusions. These patients have posed the challenge of whether we can meet their needs. The answer has been yes. We welcome the opportunity to treat these patients – a number of whom come from out of state to be treated at Allegheny General Hospital. In treating any patient, it is important to understand and respect their concerns and beliefs.
Are there any special techniques or equipment that you use to decrease transfusion requirements?
For the most part, “bloodless” procedures require a high level of technical execution by the physician and the Operating Room staff. All of the members of our team have worked to make this possible. We are confident in our ability to meet this challenge.
Most of the patients who are Jehovah’s Witnesses that I have treated are willing to accept the use of cell salvage. The equipment captures and re-circulates red cells lost during surgery. As long as the equipment is set up in a closed circuit so that the patient’s blood is neither separated from the body nor stored, it complies with the beliefs of the community. We utilize this technique as a safety valve for such patients; however, we have rarely, if ever, had to actually activate the equipment.
Are there any special considerations that a ‘bloodless’ patient should have when faced with treatment for a urologic condition?
At times, these patients have reported concerns about whether they should
consider surgery in view of their beliefs. Some physicians reluctant to
operate on bloodless patients told these patients not to proceed with surgery.
We inform patients that their refusal of blood transfusion does not eliminate
surgery as an option. I consider all options, including surgery, to be on
the table for these patients. Surgery may not be the best option for certain
patients, but for those who would benefit, it remains a viable option.
