Making the Decision About Endoscopic Surgery
When is minimally invasive surgery better than traditional surgery? What are the risks?
Cynthia Dennison Haines, MD
Endoscopic or minimally invasive surgery is the hot new surgical trend. It can significantly reduce scarring and recovery time. But it isn't right for everyone. Here are some suggestions for things to do - and think about - before you and your doctor settle on an approach.
Do some research. Is there solid evidence that a minimally invasive technique is appropriate for the operation you need? Though some have proven safety and success rates, others are still being tested.
"If there isn't good evidence for a procedure's safety and effectiveness, I'd say 'No way,'" says Mohamed Ali, MD, director of minimally invasive and robotic surgery at the University of California at Davis.
Stay open to different approaches. It's important not to into a minimally invasive approach that he or she isn't comfortable with. In some cases, it just isn't the right choice.
"Don't talk your surgeon into doing minimally invasive surgery," says Mehmet Oz, MD, Director of the Cardiovascular Institute at the Columbia University Medical Center in New York. He explains that surgeons may be susceptible to pressure. "If a surgeon thinks that you are going to drop him unless he agrees to do the surgery you want, he might give in against his better judgment," he tells WebMD.
If you force a surgeon into a technique that he or she isn't comfortable with, you increase your risks. "You will become an experiment," says Oz. "Most of the catastrophes that happen in the operating room are the result of surgeons who are just beginning to learn how to do an operation and are pushed beyond their comfort zone."
Get a second opinion. "I don't understand patients who don't get a second opinion," says Oz. "You would never buy a car after only looking at one dealer."
Some people are worried that getting a second opinion will offend their current doctor. But that shouldn't be the case.
"Your surgeon should encourage you to get a second opinion," says Steven D. Wexner, MD, chief of staff and chair of the department of colorectal surgery at the Cleveland Clinic Florida. "If he doesn't, or if he goes ballistic when you say you want to check with another doctor, that's a bad sign. There's no reason for a surgeon to be defensive like that."
Find out if your surgeon's colleagues are also using minimally invasive techniques. This isn't an obvious consideration, but Oz says it's important. It's important that everyone in the department - not just a single surgeon, be experienced with minimally invasive surgery. "If only one surgeon is doing the operations, it could mean that the rest of the team - the nurses and the anesthesiologists - won't have much experience with the procedure yet," he says.
Understand the details. If your surgeon tells you that your operation will be , find out exactly what that means. On its own, "minimally invasive" is pretty vague. Oz says that, sometimes, a surgeon with less experience might call an operation minimally invasive that real experts would call open surgery. So ask specifics. How many incisions will there be? Where will they be? How large will they be? What instruments will the surgeon be using? How long will the operation take? Then compare the information to what other surgeons tell you, or to what you find out during your own research.
Published Oct. 26, 2005.