New “Mini” Instruments Provide Surgeons A Third Option For Minimally Invasive Surgery

Setting it Apart from Traditional Laparoscopic and Robotic Surgeries, ‘Mini Lap’ Surgery Now Works for Major Operations

Orlando, FL—The world of mini-laparoscopic surgery is evolving, and surgeons from more than 27 countries convened last week at the EuroAmerican Multispecialty Summit to test and re-learn the latest evolution of this minimally invasive surgical technique.  Conceptualized in 1987, “mini-lap surgery” has now progressed as a therapeutic tool using improved, smaller instruments that will almost diminish patient scarring and, according to the surgeons, will increase its safety while decreasing the cost.

“Standard laparoscopic surgery is now three decades old,” says Dr. Phil Shadduck, a general surgeon at Duke Regional Hospital. “Beyond robotics, which can be more expensive, we have been asking, ‘what is the next step?’”  The Society of Laparoendoscopic Surgeons (SLS), the group for minimally invasive surgeons, met on February 11 to 13 to address this new method with multi-specialty teams from several countries. The group met to examine new methods that will help improve patient outcomes.

How it Works

With traditional laparoscopic surgery, larger trocars compete for space as the surgeon performs the operation, limiting visibility and producing some scarring. With mini-laparoscopic surgery, a needle-sized trocar is used and greater visibility and improved dexterity is achieved, allowing for more angles and an easier surgery.  The pinpoint incisions are much smaller as well, using only two-to-three millimeter instruments, which decreases pain for the patient and allows for faster healing.  Because there is less equipment to be re-used, costs are significantly lower.

“This is a major breakthrough for all medical specialties. Particularly on pediatric patients, smaller needles and less equipment are beneficial.  Women will also benefit from cosmesis, less pain, being able to return to normal routines earlier,” says Dr. Paul Wetter, chairman of The Society of Laparoendoscopic Surgeons. “When you ask a patient do you want a small needle or a big one, the answer is obvious. For these reasons, we invited Internationally known MIS surgeons from the areas of ob-gyn, general surgery, pediatric, urology and plastic surgery to our Euro-American Summit, and the response was very positive.”

The courses at the Summit went over the new technique as a therapeutic tool, evolved from diagnostic technology only to a new surgical treatment.  “Currently, a very small amount of surgeons are using mini-laparoscopy because the older, smaller instruments couldn’t be used on large operations,” says Dr. Jay Redan, president of SLS and a general surgeon at Florida Hospital.  “After evaluating studies in Brazil, we are going to encourage surgeons to use this method because there are so many benefits.”

Companies that manufacture these products are realizing that surgeons and hospitals want fewer instruments and lower costs with better and more efficient techniques.  They claim that patients want better outcomes and less pain and scarring. “When this method was introduced, we could not use it on most operations, says Gustavo Carvalho, professor of surgery at Pernambuco University, Brazil, who conducted several recent studies on mini-laparoscopic surgery.  As we continue to evolve, with the new low friction mini-instrumentation and the demand for more safety and less cost, we are able to perform larger operations with smaller low friction instruments, which decreases pain, almost eliminates scarring, and makes the operation much less tedious, so that it’s easier to learn and perform.”

When larger instruments are used, they create trauma to the abdominal wall.  This has found to be especially sensitive for children.  “With adults we use very large instruments.  For children, smaller incisions are very important because there is less pain, something children can have a tough time dealing with,” says Dr. Gustavo Stringel, professor of surgery and pediatrics at New York Medical College.  “When parents see the advantages, they are the best advocates for this kind of new technology.”

“All surgeries come with risks,” reminds Wetter.  “This is not a ‘seatbelt,’ but rather a new method that improves surgical outcomes.  For that reason, I’ll take it.”