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Exploring the Mini-Lap of Today

By Rebecca Rudolph

What if laparoscopic procedures could be done with smaller tools, which would mean smaller incisions and less damage to the patient’s tissues? That question was asked in the early to mid 1990s, and mini-laparoscopy, also known as micro-laparoscopy and needlescopic surgery, was born. Instruments and tools were launched, but there were some problems. “The instruments had some real technical limitations with flexibility, lack of insulation, poor instrument durability and so forth,” said Dr. Phillip Shadduck, general surgeon at Duke Regional Hospital and North Carolina Specialty Hospital.

The idea was put to the side and other new ideas emerged – single incision laparoscopy, natural orifice surgery and computer assisted robotic surgery. “There have been limitations on each of those platforms, as far as ergonomics, OR time, cost and other things, and as a result none of them replaced standard laparoscopy,” Shadduck explained. “That history led people to circle back to mini-laparoscopy over the last few years.”

There was a new challenge; surgeons associated the new instrumentation with the past. “Really, every piece of the  mini-laparoscopy instrument system has improved, and that is what has made what’s in our hand now so different to what was in our hand 20 years ago,” he said. “We haven’t really figured out the right terminology to use for this newer generation of small instruments.”

The smaller tools only need about a 3 mm incision and don’t require suturing at the facial or skin levels. He added that one new design focuses on low friction, which means the movements are fluid and precise. The same procedures that can be done with traditional laparoscopy can be done with mini-laparoscopy, including hernia repair, cholecystectomy, appendectomy, organ surgery and resectioning.

“There are clinical papers coming out on mini-laparoscopy with the newer instruments, but they’re pretty limited right now, (because) it’s pretty early,” Shadduck said. “That’ll be helpful. A lot of us want to see the data.” Until then, he thinks educating surgeons on the differences between the mini-lap of the 1990s and the mini-lap of today is a challenge. Once surgeons get their hands on the new instruments, it’s hard not to see the difference in technology, he concluded.

The Society of Laparoendoscopic Surgeons (SLS) met earlier this month to discuss these differences.  “Currently, a very small amount of surgeons are using mini-laparoscopy because the older, smaller instruments couldn’t be used on large operations,” wrote Dr. Jay Redan, president of SLS and a general surgeon at Florida Hospital, in a press release.  “After evaluating studies in Brazil, we are going to encourage surgeons to use this method because there are so many benefits.”

Source: Surgical Products Magazine

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