In the quest for the Holy Grail of nearly scar-less minimally invasive surgery, 73 physicians and 5 veterinarians from 15 countries are gathering in Philadelphia this week to hear success stories, view technologies and learn techniques for what the event's organizers have dubbed "reduced port surgery."
The Reduced Port Surgery Group's first annual International Symposium and Lab, hosted by the husband-and-wife team of Paul Curcillo, MD, and Stephanie King, MD, of Philadelphia's Fox Chase Cancer Center, includes presentations and demonstrations from global leaders in minimally invasive general surgery, gynecology, urology, bariatrics, robotics and veterinary surgery.
The sessions are all focused on ways to reduce incisions, ports, pain and scarring in minimally invasive surgery through a veritable alphabet soup of innovative techniques: Single Port Access (SPA), Single Incision Laparoscopic Surgery (SILS), Laparo-Endoscopic Single-Site (LESS), and more. Although sanguine about the potential of these reduced port techniques to surpass NOTES (natural orifice translumenal endoscopic surgery) as the most viable nearly scar-less technique for abdominal and pelvic procedures, the presenters were also realistic about this still-emerging area of minimally invasive surgery.
Some takeaway points from the first day of presentations:
Current research shows that reduced port techniques for common general surgical procedures such as cholescystectomy are as good and as safe as multi-port laparoscopy, but there is not enough evidence to show that they're actually better from a clinical perspective.
The proven benefits of reduced port over multi-port laparoscopy are cosmetic: Operating through a single incision at the belly button makes these procedures virtually scar-less, which in turn boosts patient satisfaction.
Patients are increasingly aware of this option and are beginning to request reduced port surgery for the cosmetic benefits.
Reduced port surgery is not for everyone: Not all patients are good candidates for it, and not all surgeons will be proficient enough to perform it.
Reduced port surgery poses technical challenges, such as the "chopsticks" effect from instrumentation clashing in the tight surgical field, that must be overcome with training and technological improvements. (On Wednesday, surgeons attending the event can complete a procedure in a practical lab set up at the University of Pennsylvania School of Veterinary Medicine.)
Vendors are responding to the demand for better laparoscopic equipment and instrumentation to overcome some of these challenges associated with reduced port surgery. However, some proponents contend certain reduced port surgeries can be performed cost-effectively using traditional laparoscopic tools.
"Reduced port surgery is no better than multi-port, but it's as good. And the benefits are greater," said Dr. Curcillo in his presentation on single port access cholecystectomy on Monday, referring to the cosmetic and patient satisfaction benefits of his technique.
A strong advocate of an incremental approach to reduced port adoption, Dr. Curcillo recommends that surgeons begin by using familiar laparoscopic instruments and slowly working their way down from 4 ports to 3 to 2 to 1. "If you change one thing at a time, it's amazing over the course of time how much you can change without realizing it."
The Reduced Port Surgery Group plans to hold its next symposium in Bombay, India, in May 2012.
Irene Tsikitas
Photo: Paul Curcillo, MD, and Stephanie King, MD, of Philadelphia's Fox Chase Cancer Center perform reduced port laparoscopic surgery.
