Archive December 2015 XVI, No. 12

Ask the Experts: Should You Add Mini-Laparoscopy?

Top surgeons share their thoughts on the tiny tools and whether the technique is worth adding.

Kendal Gapinski

Kendal Gapinski, Contributing Editor


Mini-laparoscopists TINY HOLES Mini-laparoscopists use 2 mm to 3 mm instruments to convert secondary ports into mini-ports to reduce scarring.

Mini-laparoscopy is becoming increasingly popular, gaining a foothold in surgeries where fewer and smaller incisions matter from a cosmetic and an abdominal safety standpoint, including cholecystectomies, appendectomies and tubal ligations. Here's what 3 mini-lap surgeons say you should know before adding the technique to your repertoire.

Is mini-lap a difficult technique to master?
Dr. Novitsky: The techniques are nearly identical — you're just using smaller instruments and incisions. Whether you use mini-lap depends on the surgeon's skills, the patient's body habitus, and if the smaller tools and incisions are appropriate for that procedure.

Dr. Reardon: Making the move to mini-lap from laparoscopy is fairly easy, especially if you're converting to 3 mm instruments. I originally started using mini-lap in 1996, after a rep brought in the technology and asked if he thought I could use it. Funny enough, a gallbladder case came into the hospital while the rep was there, and I asked if we could test out the technology right away. That case went so smoothly that we've now grown to use 2 mm and 3 mm instruments in nearly all of our procedures.

Dr. Curcillo: There is a spectrum of laparoscopic surgeons using the technology. Some who use mini-lap exclusively, and then there are those who won't touch it. I think most fall in between and see it as another skill available for select cases.

Which procedures are good matches for mini-lap?
Dr. Novitsky: Mini-laparoscopy is fairly common in tubal ligations and other GYN procedures, as well as in cholecystectomies, appendectomies and select intestinal procedures. I wish it was used in more general surgery cases, like inguinal hernia repair, since it's much less invasive to the abdomen.

Dr. Curcillo: Colorectal and bariatric surgeons are also trying to get into it, though that's more of a challenge since the small instruments are hard to use on those who are obese or who have a lot of disease present. I typically perform single-port surgery, but when that isn't an option, I'll do a reduced-port procedure. If I'm doing a gallbladder through the belly button, but I can't quite maneuver it how I need to, I'll insert a 3 mm instrument percutaneously to assist me. This limits scarring while still giving me the help I need from an additional entry point.

Dr. Reardon: We use it as both an addition and an alternative to conventional laparoscopy. It depends on the case. For a surgery that doesn't require you to remove a specimen, insert a device (like mesh) or use a stapler, you can do the entire case through 2 mm or 3 mm ports. Otherwise, you can have 1 or 2 larger (5 to 12 mm) ports and just convert the secondary ones to mini ports. We recently added bariatric cases and use a 12 mm port for the stapler, a 5 mm port for the camera and 3 3-mm ports for the instruments.


Yuri Novitsky, MD, FACS
Dr. Novitsky is a professor of surgery, director of the Case Comprehensive Hernia Center and director of the advanced GI surgery and MIS Fellowship at University Hospitals Case Medical Center in Cleveland, Ohio.

Patrick Reardon, MD, FACS
Dr. Reardon is the chief of minimally invasive surgery and chief of foregut surgery at Houston (Texas) Methodist Hospital and professor of clinical surgery at Weill Cornell Medical College.

Paul G. Curcillo, II, MD, FACS
Dr. Curcillo is the director of minimally invasive surgical initiatives and development at Fox Chase Cancer Center in Philadelphia, Pa.

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