Tinier Surgical Instruments Can Reduce Post-Op Pain, Scars
April 3, 2000 (Atlanta) -- Operations that once meant a lengthy hospital
stay, a long and painful recovery period, and permanent scarring may be less
painful, virtually scar-free, and require much less time in a hospital bed,
thanks to a new technique called needlescopic surgery.
The point of less-invasive types of surgery such as needlescopic and
laparascopic, which use small incisions, small surgical tools, and a
telescope-like instrument, is to diminish the trauma to the abdominal wall
"so patients have less pain, smaller scars, and recover quicker," says
researcher Joseph Mamazza, MD.
"In needlescopic surgery, the size of the instruments is reduced from
the 5-12 mm diameter of standard laparoscopic surgery to less than 3 mm,"
says Mamazza, MD, who presented his team's findings here Monday at a meeting of
the Society of American Gastrointestinal Endoscopic Surgeons.
Because needlescopic instruments are so fine and sharp, some people had
feared they might increase the threat of organ perforations, "but in fact
we saw no difference in complication rates between needlescopic and
laparoscopic surgery, and we also saw a trend toward shorter hospital
stays," Mamazza tells WebMD. He is medical director of minimal-access
therapeutics and director of minimally invasive surgery at St. Michael's
Hospital at the University of Toronto.
The researchers compared results of needlescopic and laparoscopic procedures
in patients of similar ages, genders and weights. The 101 chest and abdominal
operations included gall-bladder removals, spleen removals, and various
procedures on the stomach and intestines. There were no deaths in either
Operating time was significantly shorter for needlescopic than laparoscopic
surgery in two of the types of procedures, and was equivalent in the rest.
There was also a strong trend for shorter hospital stay for some of the
operations, which will probably reach statistical significance as the number of
surgery recipients who are studied grows, says Mamazza. "Regardless of
whether it's considered statistically significant, it still translates into
significant cost savings, if nothing else," he tells WebMD.
Mamazza tells WebMD that most surgeons "know intuitively" who is and
isn't a good candidate for needlescopic surgery. Nonetheless, he says, the
technology does have limitations, and there are some basic caveats.
"At the present time, big people, big organs, and major gastrointestinal
surgeries are difficult to deal with by needlescopic surgery," he says. The
development of sturdier instruments may change things, but for now, "the
bottom line is that obese patients are not good candidates, and this does not
work for removing heavy, enlarged organs, because the instruments will
In the right patient, however, needlescopic surgery is an attractive option.
Mamazza says he would offer needlescopic surgery to some patients with the
understanding that he might have to switch to standard instruments during the
"In the middle of the procedure," Mamazza tells WebMD, "if there
is difficulty, the surgeon can upgrade to larger instruments or even to
traditional open surgery."
- Needlescopic surgery is a technique that uses surgical instruments 3
millimeters in size, compared to the 5-12 mm size of standard laparoscopic
- This new type of surgery is shorter, less painful, leaves only very small
scars, and requires a shorter hospital stay.
- Needlescopic surgery may not be appropriate for obese patients or for
operating on larger organs.