CLEARLY SEE WHAT TO EXPECT DURING AN OPERATION
Dr Konstantin Feise, a dermatologist and phlebologist working in aesthetic medicine, provides sclerotherapy, catheter-based laser surgery and diagnostic investigations on venous systems, for patients in and around Stuttgart, Germany. He uses point-of-care ultrasound to help get a firm picture of his patients’ requirements and anatomy before surgery, and to guide procedures.
I first started to use ultrasound when I scanned and examined over 250 patients for a doctoral thesis in venous diseases which I undertook in Heidelberg in 2002. After that, I used ultrasound daily in normal clinical practice in a hospital in Stuttgart, and then again in an aesthetic clinic in Darmstadt. This is when I first started to perform catheter- based procedures, using both radiofrequency and laser ablation therapies, both guided by ultrasound, as well as echosclerotherapy.
Ultrasound forms an essential part of my practice. I simply never carry out any phlebology treatment without performing my own ultrasound examination first. Sometimes, referrals come from dermatologists or other clinicians who have already done some investigative work.
However, I always insist on looking for myself, to establish the correct therapy for each patient, and thoroughly map their venous system in the first instance. Equally, when it comes to the therapy itself, I need to have a clear ultrasound view of the area being treated. I always use ultrasound, for example, to guide the ELVeS Radial™ laser therapy [biolitec®] or Closure Fast™ radiofrequency [Covidien] systems I frequently use for venous insufficiency. Whatever procedure I’m carrying out – whether I’m puncturing a vein with a needle, or moving a catheter forward in the saphenous veins – I need to be sure that everything is in the right place.
Point-of-care ultrasound is used for a number of procedures at the Sophienklinik, a well-established aesthetic clinic in the heart of Stuttgart where I am an attending specialist. It is sometimes quite useful to be able to have a look at the fat tissue you are about to remove prior to liposuctions of lipoedemas. Similarly, it is very helpful to see clearly whether lipomas are growing in or above muscle tissue before excising them. In both situations, ultrasound helps us to clearly see what to expect during the operation. Other times, it acts as a guide, for example, for puncturing seromas that may have formed following breast surgery.
In Darmstadt, I used a SonoSite MicroMaxx® ultrasound system and decided to stay with a SonoSite system when I started my own private practice in Stuttgart. I did have a look at other point-of-care instruments that were available, but I was more than happy with what I had used before and there was no reason to change.
I find the SonoSite M-Turbo® easy to use, with not too many buttons and a small menu with quite nice settings. The image quality is really good, it has a fast boot-up time and is reasonably priced. It is also very handy to carry around and robust, which is ideal when I use it both in examining rooms and in the operating theatres.