Mini-laparoscopic surgery is gaining favor among thought leaders in surgery. Find out why some experts believe “mini-lap” should be used more frequently.
By Marie Thibault
Although mini-laparoscopy, a surgical technique that allows for even smaller incision sites than traditional laparoscopy, has been performed by some surgeons for years, the technique may finally be coming into its own. Surgeons who have been perfecting “mini-lap,” as it is known, believe it is better not only for cosmesis, but is also better for surgeons and comes with fewer patient side effects.
This flies in the face of what many believe. Some in the medical profession have dismissed mini-lap as allowing for smaller scars in easy cases but not good for much else. Penetration of the technique is estimated to be in the single digits globally.
Speaking during a September 1 roundtable held at the Society of Laparoendoscopic Surgeons’ (SLS) Minimally Invasive Surgery Week annual meeting in New York City that included surgeons and representatives from the medical device industry, Dr. Gustavo Carvalho, professor of general surgery at Pernambuco University in Brazil, discussed what he calls the “myths” about mini-lap. “For example, many people think that mini is not good for acute cases or complex cases or difficult cases. Really, it’s just the opposite. . . “
To bolster his point, Carvalho refers to soon-to-be-published research that shows that “we could observe that for very precise and very delicate tasks, mini does much better . . .” He says these findings demonstrate that “with mini, you can do not only a surgery that is more cosmetically better but also something that you can improve surgical movement and reduce surgical stress for the surgeon. So it’s something that’s not only good for the patient but also for surgeons.”
Dr. Paul Wetter, founder and chairman of SLS, points out that mini-lap, like the trend toward minimally invasive surgery, makes sense for patients, because a smaller incision would logically come with a shorter hospital stay.
Dr. Jay Redan, general surgeon at Florida Hospital and president of SLS, acknowledges there are skeptics: “Unfortunately, people think, ‘5 mm or 3 mm, eh, what’s the big deal?’ It is a big deal,” he says, adding that he was once skeptical too. “I tried it out, the scars are invisible. I don’t need to put sutures even in my port sites. Steri-Strip or some glue and that’s it. It’s a very dramatic, real difference in seeing it and getting the experience by a very small adjustment on technique.”
Advancements in surgical tools have made mini-lap easier to perform. “The difference now, the differences in engineering and production, this new generation of smaller instruments actually perform as well as the larger instruments . . . I think that’s the key message here . . . Now we have these tiny instruments that go in with no trocar, a tiny incision, and perform just as well as larger instruments,” says Wetter.
The surgeons believe that mini-lap can eventually become standard of care, with penetration perhaps reaching as high as 50%, but that this shift may take five to ten years.
Redan says awareness and education is key to increasing use of mini-lap. “Everything is here, everything we need is here, the only thing we’re missing now is awareness on the patient’s part, awareness and education on the surgeon’s part . . .” he says.