Minimally Invasive Surgery And The Ever Shrinking Incision

2009-02-07 | |
Last updated: 2009-02-07

Since the advent of minimally invasive laparoscopic surgery in the 1980s, more and more surgical procedures have evolved to use the technique and the results have been very positive for patients. Laparoscopic surgery, or pinhole surgery, involves creating one or more small incisions of around 1 cm (1/2 inch) in size and inserting video cameras, light sources and surgical tools through the incisions to access the area to be worked on. This approach is called minimally invasive because patients do not have to experience and recover from the larger incisions used in more traditional forms of surgery.

After studying the effects of laparoscopic surgery on patients for a number of years, studies have found that the pain following surgery is less, healing times are usually much shorter, risks of infection are reduced and scarring is much less than was seen with traditional forms of surgery. Most patients would undoubtedly agree.

Following this great success, surgical pioneers are now extending their investigations to further reduce the effects on patients. Some surgeries are now being performed using only a single 1 cm (1/2 inch) incision. To date, surgeons have begun performing a number of types of operations such as gastric bypass or stomach stapling and the removal of different organs such as the gall bladder, spleen, appendix and colon through one small hole. The recovery times for patients and risks of complications, already decreased with laparoscopic techniques using multiple incisions, are further decreased when only a single incision is used.

The next step in this surgical evolution now seems to involve not penetrating the skin at all but instead using techniques to access the body through naturally existing openings such as the mouth, rectum, penis and vagina. The recent announcement that a women had had a kidney extracted intact through an incision inside her vagina is the latest in a string of surgeries using “natural orifice” access. This trademarked technique called Natural Orifice Translumenal Endoscopic Surgery or NOTES for short has also been used to remove patient gall bladders through the vagina and mouth, and to perform removal of the appendix through the mouth.

While laparoscopic surgery is more mature and more commonly practiced than the more experimental “natural orifice” surgery, both approaches are still being advanced. Techniques to perform more complicated surgical procedures are being developed and being used. Some forms of surgery for lung cancer can now be performed laparoscopically instead of using 10 to 25 cm (6 to 10 inch) incisions and rib spreading. Rebuilding of a patient’s stomach valve to prevent severe acid reflux has also been performed. Even heart valve surgery is being performed with smaller incisions, albeit, not the size used with laparoscopic approaches. Each of these advances reduces the risks, complications and pain to patients and that is good for the patient’s well being and for reducing costs to the medical system.

The only downside of these advances, it would seem, are the rates of adoption of the new techniques. The skills required to perform surgery using these approaches are very different than the skills required for more traditional surgical approaches. That means that patients, you and me, may have to endure the more invasive approaches while waiting for the time when the legal system approves the surgery, the insurers will pay for the procedures and the surgeons have time to learn the new methods. While it will take longer than most people awaiting surgery would like to wait, at least the trend is in the right direction.

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