Skin Protection, Pre-surgery Light Test Allowed Safe Surgery in Patient
A pre-surgery light sensitivity test and appropriate skin coverage during surgery allowed a safe and successful laparoscopy — a type of minimally invasive operation in the abdomen or pelvis — in a man with erythropoietic protoporphyria (EPP), scientists report.
Since EPP is marked by skin hypersensitivity to sunlight and some types of artificial light, these measures may help prevent light-induced skin and organ damage during this type of surgery, the researchers said.
The case study, “Single-incision laparoscopic partial cecectomy for appendiceal mucocele in a patient with porphyria photosensitivity,” was published in the Asian Journal of Endoscopic Surgery.
Porphyria comprises a group of genetic disorders caused by disruptions in producing heme, a molecule in red blood cells that transports oxygen around the body. When a step in the heme production pathway is disrupted, porphyrins and other precursor molecules build up in various tissues and organs, such as the skin, blood, and liver, causing damage.
A form of cutaneous porphyria, EPP is characterized by protoporphyrin accumulating in the skin, making it extremely sensitive to sunlight and some types of artificial lights, such as those used in surgery.
Light exposure during surgery has been reported to cause damage to the skin and intra-abdominal organs, including intestinal burns and holes. It’s therefore crucial to minimize or avoid light exposure to such patients during surgery.
Researchers at Kyoto University, Japan reported the case of a 55-year-old man with EPP who underwent a laparoscopy without complications after several preventive measures were implemented.
Laparoscopy, also known as keyhole surgery, is a minimally invasive operation that allows access to the inside of the abdomen and pelvis through a small incision in the skin.
The procedure is guided by a small tube with a light source and camera called laparoscope. It’s associated with a shorter hospital stay, faster recovery time, less pain and bleeding after the operation, and reduced scarring.
The man, who showed significant sensitivity to sunlight but not to regular room light in daily life, was admitted to the hospital to treat a dilated, mucus-filled appendix.
Additional exams suggested no cancerous tissue in the appendix and showed that the man’s cecum, the first part of the large intestine, was compressed and the opening to the appendix was concealed. The doctors decided to remove the appendix and part of the cecum.
The researchers first confirmed that the room and surgical lights in their operating room rarely contained light in the blue spectrum, to which EPP patients are most sensitive. The man did not show sensitivity to operating room and surgical lights.
An additional pre-surgery light sensitivity test was performed with two laparoscopes made by different manufacturers on two small skin sections on his back.
Before exposing him to light from the laparoscopes, the researchers covered his back (except the two test areas) with a black cloth and then exposed him to the laparoscopes’ light for 30 minutes. The light of one of the laparoscopes caused skin redness and itching, while the other had no effect and was used for the surgery.
To avoid unnecessary exposure to surgical light during the procedure, the man’s skin was completely covered with surgical drapes except at the incision site and the umbilical incision was protected with a wound-covering device.
The surgery was successful, and the man did not develop complications during and after surgery. An examination of the removed tissue showed cancerous growths in the appendix.
“To our knowledge, this is the first report of single-incision laparoscopic [large intestine surgery] in a patient with EPP,” the researchers wrote.
“A preoperative light test may be useful to enable safe laparoscopic surgery in patients with EPP,” the research team wrote, adding that “single-incision laparoscopic surgery combined with appropriate use of surgical drapes ensured a safe and successful operative procedure.”