Tinier Surgical Instruments Can Reduce Post-Op Pain, Scars

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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.

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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 group.

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.

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"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 break."

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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 operation.

"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."

Vital Information:

  • Needlescopic surgery is a technique that uses surgical instruments 3 millimeters in size, compared to the 5-12 mm size of standard laparoscopic instruments.
  • 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.
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