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New ‘mini’ surgeries offer little over original

New ‘mini’ surgeries offer little over original

From a January 31, 2011 Health Day news item by Lynn Peeples

Single Incision Laparscopic Surgery 3

Single Incision Laparscopic Surgery 3


NEW YORK (Reuters Health) – A new surgical technique that involves “mini” incisions may not offer many advantages over the already minimally invasive standard, suggests a new review of studies comparing the two types of laparoscopic gallbladder surgeries.

“To be honest, it is really hard to improve on conventional laparoscopic,” senior researcher Dr. Shiva Jayaraman of the University of Toronto told Reuters Health in an e-mail.

The surgical removal of the gallbladder is primarily performed to treat gallstones. The standard “closed” procedure — so called because the abdomen doesn’t need to be opened with a large incision — debuted in 1987. It’s already an improvement over earlier surgeries that left patients in greater pain and with larger scars

But a desire for even better cosmetic results has led to an increasing push toward surgical options that are less and less invasive, said Jayaraman.

To see if the newer options are worthwhile for patients, he and his colleagues looked to the literature for studies that compared conventional laparoscopy in gallbladder surgery to the newer, more cosmetically friendly approach: mini-laparoscopy.

The team pulled together 18 studies conducted between 1999 and 2007, including a total of more than 1,500 patients.

They found that the odds of a surgery technique failing — and being completed by a different procedure — were more than twice as high for a patient undergoing mini-laparoscopy compared to the conventional version: 10 percent versus 4 percent.

However, while failed conventional laparoscopic surgeries are always converted to open procedures, mini-laparoscopies could simply transition into conventional laparoscopies.

This higher failure rate of the mini-laparoscopy might also be reflecting the newness of the procedure to surgeons, and the difficulties they may have learning it.

The smaller cuts and miniature tools involved in mini-laparoscopy did provide somewhat better cosmetic results. A month after the surgery, patients gave their scars an average rating of one on a scale of one to ten, while the average score in the conventional group was a three.

Most patients undergoing either conventional or mini-laparoscopy to remove their gallbladder go home the same day as their surgery, and return to work within four to six weeks. Mini-laparoscopy patients in Jayaraman’s study returned to their normal activities slightly sooner than the conventional laparoscopy patients, report the researchers in the Annals of Surgery.***

“That may represent a cost-savings to society from less work days lost,” noted Jayaraman.

The length of the surgery and risks of complications, including severe bleeding and infections, were similar between the groups. No deaths occurred from either surgery.

The researchers note that specialized equipment could put a slightly higher price tag on mini-laparoscopy, although the reusability of the instruments should keep costs comparable. Conventional laparoscopy runs around $7,000.

Jayaraman’s team suggests that more research is needed to clarify the costs and benefits of mini-laparoscopy, and if certain variations on the technique are better than others.

“Conventional laparoscopic gallbladder surgery is very successful at providing minimally-invasive, cosmetic, and effective treatment of diseases of the gallbladder,” said Jayaraman.

“In the end, both of these approaches are very safe,” he added. “If cosmetics is very important to a patient, then a ‘mini’ approach might be a good option.”

*** For suggestions on how to get this article for free or at low cost, click here

February 2, 2011 - Posted by | Medical and Health Research News | , , , ,

1 Comment »

  1. Minilaparoscopy is the major contribution in the hybrid and practical way to perform Natural Orifice Transluminal Endoscopic Surgery, the new surgical revolution in minimally invasive surgery. My opinion, Minilaparoscopy Assisted Natural Orifice Surgery makes a difference and is here to stay.

    Comment by Tsin | February 26, 2011 | Reply

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