Minimally Invasive Surgery

July 27th, 2014 @   -  No Comments

I love research studies especially when the result has a solid outcome that benefits my patients. A recent retrospective study conducted at John Hopkins Hospital took a look at how often hospitals use minimally invasive surgery. The discovery was pretty interesting.

Minimally invasive surgery or laparoscopic surgery can be used to treat many conditions. In minimally invasive procedures, the surgeon makes one or more incisions, each about a half-inch long, to insert a tube. The number of incisions depends on the type of surgery. The tube or tubes let the surgeon slip in tiny video cameras and specially designed surgical instruments to perform the procedure. Typically I perform cases laparoscopically whenever I can because my patients will have less postoperative pain, fewer and smaller scars, and a faster recovery than with open surgery.

Now back to the study. The study examined four common procedures appendectomy, hysterectomy, colectomy and lung lobectomy—at more than 1,000 hospitals. When the procedures were performed using the minimally invasive techniques, serious complications were substantially lower for all four procedures. That was an expected finding.

What was completely unexpected was the utter unpredictability of the use of minimally invasive surgery. For appendectomies 1/3 of U.S. hospitals use the open method of surgery, 1/3 uses both open and laparoscopy, while 1/3 uses the minimally invasive technique about 90% of the time. A patient has virtually no way of predicting how most general surgery cases are performed.

So what really causes such disparities in surgical procedures? The study proved that there is little or any correlation between the use of minimally invasive procedures to the size, location, or affiliation of the hospital. It seems that surgeons who aren’t trained to offer laparoscopic procedures to their patients, won’t. It’s that simple. Granted there are cases where a patient is simply not a candidate for a laparoscopic procedure, and the discretion of the surgeon should be respected.

The Johns Hopkins study and many others have shown that minimally invasive surgery reduces complications. Considering skyrocketing healthcare costs, a surgeon’s familiarity with the latest minimally invasive techniques, should be a quality measure patients seek out.

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