Last year our business has increased by 14

It vaporizes tissue and there is no bleeding. This debit greatly. "Dr. Hervé Baumert, head of the Department of urologique surgery in the hospital group Paris Saint-Joseph, uses a vocabulary of engineer to describe a very classical intervention: the removal of an adenoma of the prostate. "We use a laser to 70 watts. "We have two to three years of decline with this technique and the first results are satisfactory," adds the Parisian doctor. The Hospital of the South of the capital has classified non-invasive surgery among its development priorities. These techniques are miniaturized instruments attached to the end of a tube or catheter. These flexible tool are introduced into the body through a natural orifice or into a vein or an artery directly. Intervention or to conduct exploration, this strange paraphernalia of plumber is capped with a camera, a laser source or a clamp.

This surgery without scars present tremendous advantages for patients and care institutions. The first earn in comfort. The majority of the reviews is under slight anaesthesia and length of stay is reduced to a minimum. The latter are turning their equipment more quickly and are an economic and medical advantage in this proliferation of technical actes. "In more than 90 of cases, patients emerge the day after the intervention," provides Professor Claude Le Feuvre in the service of Cardiology of the Pitié-Salpêtrière hospital in Paris.

Stent put in twenty minutes

Reverse of the coin, the médico-économique evaluation of these innovations is often difficult. According to some practitioners, pricing activity (T2A), which codifies now all hospital acts, hinders the introduction of the new features. "When technology is too powerful, it can make us lose money because of unfavourable pricing." Result, we keep patients longer. "It's the perverse effect of the T2A," said Hervé Baumert, who speaks on behalf of a private non-profit hospital group. A view that does not share Claude Le Feuvre, an employee in the public, Assistance publique-Hôpitaux in Paris: "We have no limitations." We are the largest centre for cardiac surgery of the AP - HP. Last year, our business has increased by 14.

Insertion of a stent by a catheter almost 2 metres long, introduced in the body at the level of the wrist, illustrates the capabilities of this surgery no-scalpel. It is in fact bring a thin Spring near the heart, in a withering artery or partially blocked by an atherosclerotic plaque (cholesterol). Once implemented, this metal component of the size of a match is deployed to consolidate the walls and restore the "light" in the Navy. (see diagram). The entire operation takes place in about 20 minutes. The progression of the prosthesis and the monitoring of the operations are controlled on screens that surgeons leave not eyes. "At the beginning of coronary angioplasty, thirty years ago, the failure rate was of the order of 40." "Today, it is close to 3 " indicates Marie-Claude Morice, cardiologist at the Hospital Institute Jacques Cartier de Massy, near Paris. "We operate are octogenarians." "It was totally inconceivable once", adds Dr. Bernard Chevalier, the same centre.

"Full Metal Jacket".

This specialist of angioplasty is experimenting with a very clever and probably promised to a bright future innovation: the biodegradable stent. Two years after the installation, once the walls of the vessel finally consolidated, the spring is dissolved in the blood and disappears.

This step is not available before 2013. It may well change the lives of the particularly fragile patients. Coronary some sick, rafistolées on several occasions, are sometimes a dozen of stents. A stunning performance worth these sick bizarre nickname: "Full Metal Jacket" - this term, made famous by a film by Stanley Kubrick, is a fully coated lead munition of copper used by the U.S. Army. "Bioabsorbable stents" were developed by the laboratory Abbott ("Les Echos" on October 9, 2009). The American industrialist uses a natural polymer (polylactil acid) for weaving this cylinder of 2.5 mm in diameter whose mechanical characteristics are in principle identical to the metal versions.

Realistic images

With these techniques, some very complex procedures are considerably simplified. This is the case of the repair of a valve located inside of the heart: mitral valve. "Before, open the chest." "Today, the patient is hospitalized a few days", said Claude Le Feuvre. The low emission x-ray scanner also his rating. It produces surprisingly realistic images of the heart and its vessels. "90 Of cases, when it comes to reviews of routine or a balance of control, the scanner is an ideal tool as totally non-invasive.". "It is preferable to the coronagraph," said Professor Vincent Dor, who heads the cardiothoracic Center of Monaco (read below). But the technology is expensive. The price of a new range imaging equipment varies between 1 and 2 million euros and an active stent costs 1,100 euros. "An operation heart open is charged lump sum of 20,000 euros to social security", explained Vincent Dor. The doctors fees represent 24 of the total, those medical personnel 27 and the cost of the 24.