Surgery Lite: Understanding Endoscopic Surgery
When is minimally invasive surgery better than traditional surgery? What are the risks?
What is the safety record of endoscopic surgery? continued...
It also depends on the patient. For people who are very sick or frail,
traditional surgery may be the best approach. It reduces time on the operating
table. Other factors that might influence your surgeon's decision to use
minimally invasive surgery are your age, your weight, your general health, and
your history of surgery.
Argenziano says that patients shouldn't become too fixated on getting
minimally invasive surgery.
"There are three goals to every operation," says Argenziano. "To
fix the problem, to do it safely, and to do it with the least trauma possible.
In the best circumstances, we can do all three. But if we can't do all three,
we sacrifice the last one." Having a longer recovery is much less important
than fixing the problem and doing it safely, he says.
Next Up: Robotic Surgery
While it may sound futuristic, robotic surgery is just an extension of
minimally invasive techniques. The difference is that the surgeon is using
robotic arms instead of endoscopes and other tools.
"A robot is really just a tool for the surgeon, like a scalpel or a
clamp," says Argenziano.
The "da Vinci" system is one such surgical robot. The robot has
three or four arms that are inserted into the body through half-inch incisions.
One arm is a camera and two act as the surgeon's hands. The optional fourth arm
moves obstructions out of the way. The surgeon looks into a viewfinder and
operates the robot from a console. As the surgeon moves his or her hands, the
robotic arms inside the patient's body mimic the movements -- cutting,
suturing, or what have you.
Because different tools can be popped in and out of the robot's arms,
they've proven to be adaptable. "It's the only big-ticket device that can
be used by a cardiac surgeon on Tuesday, a urologist on Wednesday, and a
neurosurgeon on Thursday," says Argenziano.
Mohamed Ali, MD, director of minimally invasive and robotic surgery at the
University of California, Davis, says he's done 150 gastric bypasses with the
da Vinci robot. "What's nice about the robot is that it allows you more
freedom of movement than traditional laparoscopy," he tells WebMD.
It's well-suited to operations in a confined space, like prostate surgery,
But there are limits to the robot's usefulness.
"You can do a lot of different operations with the robot," says Ali.
"But the real question is whether you get a better operation or a better
result by using the robot. In most cases, especially in general surgery, the
answer is no."
One drawback is that operations with the robot can take longer, which may
increase the risks.
Another problem with is the price tag. "The machines are over a million
dollars," says Malangoni. "So most surgeons and most patients just
don't have access to one."