By Gustavo Carvalho, MD, PhD
Therapeutic laparoscopic surgery has been around for more than 25 years and surgeons, patients and administrations have begun to ask the question, what’s next? Laparoscopic surgery has gone through a number of modest modifications, with the goal to further minimize surgical trauma and improve results. Late in the 1980s, “Mini-Laparoscopic Surgery,” which uses 2-3 mm diameter instruments, was introduced and took shape in the 1990s, but did not catch on because of early device limitations, excessive costs and possible injuries. But just recently new instruments have energized the use of mini laparoscopic techniques, because new tools are being developed with improved functionality and durability. A study, soon to be published, will show how the new Low Friction Mini instruments outperform the existing tools we have at our disposal. The study is the very first to objectively evaluate a new set of mini instruments with a novel low friction design.
One cannot argue that mini-laparoscopic surgery is evolving. The Society of Laparoscopic Surgeons (SLS), arguably one of the most important medical societies for surgery today, gathered surgeons from more than 27 countries recently at its Euro American Multispecialty Summit to test and re-learn the latest evolution of this minimally invasive surgical technique, evaluating the new instruments, and teaching the technique to treat this time, rather than just diagnose. Our hope, over the last few years, has been to use “mini-lap surgery” as a therapeutic tool using these improved, smaller instruments, so that we can offer our patients almost no patient scarring, as well as increased safety with improved dexterity and visualization and reduced cost.
With mini-laparoscopic surgery, a needle-sized trocar with a ball shaped dilating tip is used, minimizing wall trauma and giving us greater visibility to examine more angles. There is also improved dexterity and visualization for an easier surgery, allowing for quicker training and more effective 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. There is less equipment to be re-used, so costs are significantly lower. But the major advantage of the new low friction mini-instrumentation is that we are able to perform the larger operations, also in combination with traditional laparoscopic trocars, so that it decreases pain, almost eliminates scarring, and makes the operation much less tedious, so that it’s easier to learn and perform.
Patients want to hear that there is a smaller needle involved. They understand that using instruments and telescopes that are smaller and thinner means smaller incisions, less pain and a faster postoperative recovery, as well as better cosmetic results for the patient. Yet the technology offers the same full functionality as its predecessors. But these particular needles have even more benefit. For the millions of children who go through surgery each year, there is no question that this will help, with smaller needles and less equipment adding to their benefit. In general, when larger instruments are used, they create trauma to the abdominal wall, and this especially affects children, who are naturally more sensitive. The larger instruments we have used for adults add to the pain and inconvenience. For children, smaller incisions are critical for reducing pain, something pediatricians want to use regularly.
Adults, needing to return to work, will be able to do so much faster, adding to the cost return for patients. Women will benefit from cosmesis, less pain, which also allows them to return to their normal routines earlier with almost no noticeable surgical marks.
Academic courses, like the one at the Euro-American Summit, should teach the new technique as a therapeutic tool, as well as for current diagnostic use. They can learn the technique now for most larger operations.
Patients now are demanding lower costs and more efficient surgeries. Surgeons and hospitals want fewer instruments and lower costs as well, with better, more efficient techniques. But everyone wants better outcomes, which is why it is so important to make surgery easier and more efficient.
Gustavo Carvalho, M.D., PhD, is professor of surgery at Pernambuco University – Recife – BRAZIL, and a Member of SLS.