Photo: Mike Itchue Dr. John Roth performs a hernia surgery at Trinity Medical Center's 7th Street campus in Moline.

Photo: Submitted This operating room in Davenport's Mercy Hospital was the site of the first successful appendectomy west of the Mississippi River. The operation was performed by by Dr. William Grant on Jan. 4, 1885. This photo is from the 1920s.

Sweeping changes in surgery over just a few decades make it a wonderful time to be a general surgeon, according to one local doctor.

Dr. John W. Roth, with General Surgery Associates, said general surgeons today have the opportunity to learn a variety of techniques and technologies that help patients heal.

"A lot of those techniques are wonderful," he said.

Routine procedures, like repairing a hernia, were done through open surgery for nearly a century. More recently, doctors have been able to do the procedure using a laparoscope. The laparoscope is a tube-like viewing instrument used to inspect, biopsy and repair tissues inside of the abdomen. Procedures utilizing a laparoscope require only small incisions (less than an inch) for the instrument to be inserted into the cavity of the abdomen.

"Some things are best done through a laparoscope, but sometimes minimally invasive means a tiny incision that we can put our instruments through without the scope," he said.

Doctors consider all of the methods and choose the one that is the safest, least invasive and most effective and can get the patient back on his or her feet most quickly with the least amount of pain or discomfort, Dr. Roth said.

Patients who 20 years ago would not have been considered candidates for surgery now can be operated on -- such as those in their 80s or 90s -- thanks to advancements in anesthetic and procedures that require less recovery time.

Many of the classic techniques still are used, but the new technology has added many options for surgeons.

"We get to do a huge variety of techniques," Dr. Roth said.

The advent of the Internet has made information about procedures available to doctors everywhere, Dr. Roth said. Even hospitals in smaller cities have the benefit of knowing the outcomes of certain procedures because they can get the information from institutions that have done a high volume of similar cases.

"As a patient, you don't have to travel to a regional cancer center," Dr. Roth said, because local hospitals offer comprehensive treatment options.

"I characterize (Trinity Regional Health System) as a low-volume, high-quality institution," he said. "We're doing a great job on a smaller scale."

The Internet also means patients are more informed.

"Patients are more informed about their disease process than 10 years ago," Dr. Roth said. "Patients are asking important questions. Still, a one-on-one discussion with your family doctor and a specialist is the best way for a patient to understand what is going on in an otherwise frightening time."

The new technology puts patients on the fast track for recovery. A gallbladder surgery used to mean a week stay in the hospital; today patients return home the same day as the procedure. A colon resection meant a week or more in the hospital, and now patients are home in two to three days.

Another change seen recently is that hospitals are beginning to track quality data.

"We're striving to reach a high standard of care, and that means measuring our outcomes," Dr. Roth said. "Now surgeons are under much more scrutiny to produce those outcomes."

The financial aspect of medicine is another factor doctors have to consider. With declining reimbursements to doctors and hospitals from insurance companies, the cost effectiveness of procedures needs to be considered, which wasn't a factor 20 years ago.

"I have to be aware of cutting costs," Dr. Roth said, adding that he has to provide high quality, safe surgeries while at the same time being careful to not bankrupt the hospital.

Despite the challenges, Dr. Roth continues to find his work rewarding.

"Every day is challenging. Every day is hard work, long hours, but every day is filled with rewards," Dr. Roth said. "I often feel like I've done something good to help someone."