Archive July 2016 XVII, No. 7

Busting 5 Myths About Mini-Lap

Don't let these misconceptions prevent you from providing the best for your patients.

Jay Redan, MD, FACS

BIO

Mini-Lap QUICK STUDY Surgeons who are adept in laparoscopic surgery can usually master mini-lap in 10 cases or fewer, says Dr. Redan.

Are your surgeons still making bigger holes in patients than necessary? Still creating scars and causing pain when they don't have to? It could be that they're not offering patients the best of minimally invasive surgery because they've bought into the many myths surrounding mini-laparoscopy. But as you'll see, it's easy to poke major holes in their mini-lap arguments.

1. It's not here yet. Mini-laparoscopic surgery isn't some fanciful idea whose day will come. It's here now. In surgery, we like to kick the tires and take our time before we adopt new ideas. But mini-lap isn't new. It's the current state of a natural evolution, one patients deserve and may even demand.

2. Mini tools aren't sturdy. Some say the instruments are too flimsy, that they're going to bend or even break. That's not true, as long as you use them properly. Twenty years ago, when we started doing laparoscopy, instruments were about 10 or 12 mm. Then, roughly a decade later, as the metals got better and the instrumentation got sturdier, we started seeing and using 5 mm tools. Now, those of us who are proficient at mini-lap are using 2 and 3 mm instruments. Combined with the stability and strength of the trocars we use with them, they've become much more robust. Improved trocars play a big role, too. Now they're made of titanium and they actually match the size of the instrumentation better. They provide stability in the abdominal wall, so the instruments don't bend or break the way they did 10 or 15 years ago. And instruments are getting better all the time. Manufacturers have caught on that mini-lap isn't just a fad. Where there used to be just one company making mini instruments, now there are several, and the competition is continually improving the instruments.

3. It's difficult to master. Actually, the reverse is true: Mini-lap is relatively easy to master. Having taught many other surgeons, I've seen again and again that as long as you're adept at standard laparoscopy, you typically need 10 cases or fewer to master mini-lap. Usually, once surgeons see it, and see how well it works, the light bulb goes on right away.

4. It's not for every patient. Some think that a high BMI makes mini-lap impossible. That's wrong. (A high BMI does make it more challenging, but it makes every surgery more challenging.) Some say because the instrumentation is smaller and sharper, it may traumatize patients. Not true. I think we're a little behind the curve in the United States, in part because we have the highest BMIs in the world. In Latin America, South America and Europe — places where culturally, people are very concerned about the appearance of their bodies and about scarring — mini-lap has become a phenomenon. There are social networking sites where people show off pictures of themselves after having mini-lap surgeries. Remember, though, high BMI doesn't have to be a deal-breaker, once you know what you're doing.

5. It's more expensive. Mini-lap instruments are typically less expensive than those of standard laparoscopic surgery. What's more, most companies are making their instruments reusable, so the cost per case is extremely low, only a few dollars.

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