Top Rated WALS Topics

  • Total Laparoscopic Hysterectomy and Bilateral Salpingo-Oophorectomy
    The role of laparoscopy total hysterectomy in performing a salpingo oophorectomy with hysterectomy has dramatically expanded in recent years but has come under increasing scrutiny regarding its benefits in certain clinical settings and its overall cost-effectiveness. A TLH is substitute for laparoscopic-assisted vaginal hysterectomy (LAVH) and substitute for a vaginal hysterectomy. As a surgeon develops expertise and experience with laparoscopic technique, the number of patients for whom he or she offers a laparoscopic approach increases. Other patients will have pathology or coexisting abnormalities that require an abdominal incision. The laparoscope therefore substitute the vaginal hysterectomy and avoids an abdominal incision when suspected or uncertain adnexal pathology or adhesive disease might otherwise preclude a strictly vaginal approach. The visualization provided allows for dissection and removal of the adnexa and the release of any adhesive disease. If no pathology exists that requires operative laparoscopy, then a simple vaginal hysterectomy is performed.
  • Fellowship in Minimal Access Surgery Batch April 2016
    Fellowship in Minimal Access Surgery Batch April 2016 at World Laparoscopy Hospital, Gurgaon
  • Laparoscopic cervical cerclage
    Cervical shortening is believed to be a marker for generalized intrauterine inflammation and has a strong association with spontaneous preterm birth. A variety of therapies, including vaginal and intramuscular progesterone, pessary, and cerclage, have been demonstrated to be effective in specific clinical circumstances. Cervical cerclage can be placed via transvaginal, open transabdominal, or laparoscopic transabdominal approach, preferably before pregnancy. A laparoscopic approach may be superior to the transabdominal approach in terms of surgical outcomes, cost, and postoperative morbidity.
  • Olympus 4K Surgery - Four Times the Resolution of Full HD
    Olympus is always trying to achieve laparoscopic visibility that is equivalent to open surgery by providing HD video imaging
    systems with advanced technologies.
    With the 4K technology, Olympus is now striving to make laparoscopic visibility even better than open surgery by adding
    features such as Ultra High Definition, Wider Color Gamut, and Magnified Visualization.
  • 5 Things to Know About Morcellation
    1 Power morcellators helped offer less-invasive surgery

    Doctors didn’t need powered morcellators, but they helped. Medical articles occasionally described tennis-elbow-like injuries for doctors wielding older, manual morcellators. In contrast, most powered versions let a tube-shaped motorized blade, inserted through a small hole in the abdomen, to do the work. Training videos show the blade cutting into the tissue, which is pulled up the tube in pieces. Tens of thousands of women had morcellator-aided hysterectomies every year, and proponents said the devices spared them longer incisions and got them back on their feet faster after surgery.

    2 They also posed a potential danger that was largely overlooked

    Gynecologists saw from the beginning that morcellators can drop bits of tissue. They also knew that what looks like a fibroid can be a hidden cancer, but many doctors say they believed that happened rarely. In some cases, doctors discounted early hints of risk. A study from South Korea in 2011 turned heads at a medical conference by showing how morcellating these tumors, rather than removing them whole, was more likely to spread cancer and worsen survival rates.

    3 Years later, the morcellator problem spilled into the public sphere.

    The issue went mainstream in December 2013 with the well-publicized case involving Amy Reed, a then-40-year-old anesthesiologist. Boston’s Brigham and Women’s Hospital said that, by using a power morcellator, it inadvertently worsened the cancer of Dr. Reed, who joined her doctor husband in calling attention to the problem. In court filings, the hospital, which is being sued by Dr. Reed, has denied wrongdoing.

    In April 2014, the FDA surprised the medical community by advising doctors not to use power morcellators. The agency said 1 in 350 women undergoing the surgery actually have a cancerous tumor that looks like a fibroid and can’t be reliably detected before surgery. Johnson & Johnson, the largest manufacturer, suspended global sales and then withdrew its device from the market that July. In November 2014, the FDA called for manufacturers to place a “black-box” warning, the FDA’s strongest, on the device.

    4 Warnings led to shift in surgeries on women

    The FDA didn’t ban the device; it said it wanted to leave a window open for the small number of women for whom the tool’s benefit may outweigh its risks. Still, the agency said any woman who does undergo the procedure should be warned that morcellation could spread unsuspected cancer.

    In the new landscape, U.S. gynecologists have changed the way they perform hysterectomies now that they no longer can readily use morcellators, according to hospitals and studies.

    While some surgeons remain dismayed about new limits imposed on the device, other doctors have said concerns that its loss would lead to major problems didn’t materialize. Instead, doctors say they turned to alternatives. The doctors are often choosing a “mini-laparotomy,” in which the uterus is removed through a small incision above the pubic bone. The incision is typically between 1 1/2 inches and 3 inches, versus roughly 1/2-inch to 3/4-inch incisions in procedures using the morcellator.

    Meanwhile, the American Congress of Obstetricians and Gynecologists recommends vaginal hysterectomies, when feasible, as having the best outcomes and fewest complications.

    5 Scrutiny of the device is still under way

    The controversy has moved to Washington and into the courts. Based on a request from Congress, the U.S. Government Accountability Office is investigating why the device was marketed for two decades before the FDA warned it can spread uterine cancer.

    In a statement on Friday, the FDA said its “primary concern is the safety and well-being of patients.” The FDA said it “was notified by the GAO of its investigation and plans to fully cooperate with the review.”

    Though device applications and other records show the FDA knew early on that morcellators could spread dangerous cells, the agency said the magnitude of the risk wasn’t realized until the issue came into the spotlight in late 2013.

    Meanwhile, dozens of other women have come forward, with many filing lawsuits. Some of these cases are being settled by J&J.

    J&J said in a statement to The Wall Street Journal last year that its morcellators “have always included cautions in their instructions for use about the potential spread of malignant (or suspected malignant) tissue.”
    • DR AJITH RAVINDRAN Thank you, sir for this article. I was interested in this topic after reading about Dr.Reed last year. Probably, like many aids in surgical/medical practice the pros and cons of using this instrument should be fully discussed with the individual patient.
    • Dr Sharmistha Ganguly Thank sir for a nice review.. is it so difficult to diagnose malignancy related to fibroid preoperatively?? A good radiologist can very well givs us the clue to the diagnosis like RI and PI low in cases of malignancy or preinvasive stage.. high flow in diastole... moreover when tissue needs morcellation , it has to be voluminous else colpotomy would suffice..in such a huge fibroid we can definitely raise high index of suspicion preoperatively and avoid morcellation if investigated properly.. MRI will add to the preoperative diagnosis..
  • Laparoscopic radical hysterectomy
    Radical hysterectomy involves surgical removal of the uterus, the supporting ligaments and the upper vagina, together with removal of the pelvic lymph nodes and sometimes the para-aortic lymph nodes. A standard radical hysterectomy is performed through an incision in the abdomen. Laparoscopic radical hysterectomy is a minimally invasive procedure that aims to achieve the same excision via a laparoscopic approach.
  • Robotic Tubal Receanalization Surgery
    Published on 11 Jun 2017
    Robotic assisted tubal reversal surgery is a surgical procedure in which the Fallopian tubes are repaired by a surgeon using a remotely controlled, robotic surgical system. The robotic system involves two components: a patient side-cart (also referred to as the robot) and a surgeon's console. The robot is placed adjacent to the patient and has several attached arms. Each arm has a unique surgical instrument and performs a specialized surgical function. The surgeon sits near the patient at the surgeon's console and visualizes the surgery through a monitor. The surgeon performs the entire reversal surgery using controllers located inside the surgeon's console.

    Robotic tubal ligation reversal uses the same small incisions as a traditional laparotomy tubal reversal surgery. Smaller incisions generally result in less pain and quicker return to work when compared to traditional tubal ligation reversal using larger abdominal incisions. The robotic system offers a greater range of motion and more surgical dexterity than a surgeon can obtain during laparoscopic tubal ligation reversal, but not as much dexterity as with an open procedure using a 2 to 3 inch incision. The disadvantages to robotic surgery are longer operating times and much higher costs than even traditional laparoscopic surgery.

    https://www.laparoscopyhospital.com
  • Dr. R. K. Mishra "The Man Behind Hundreds of Robotic Surgeons of World&quot... (finance.yahoo.com)
    http://finance.yahoo.com/news/dr-r-k-mishra-man-110300531.html
    GURGAON, India, March 31, 2016 /PRNewswire-iReach/ -- With the advent of advanced surgical and gynaecological minimally invasive surgery over the last 2 decades, a need has arisen for state of the art training programs dedicated exclusively to these da Vinci Robotic Surgery techniques. None of the medical colleges in Asia and even in Europe has training programs in robotic surgery and surgeons and gynecologists unfortunately during their residency do not get adequate experience in advanced robotic techniques once they come in active practice. World Laparoscopy Hospital is the only institute in Asia to provide Hands on Robotic Surgery Training for Surgeons and Gynecologists who come here from whole World.
  • Laparoscopic cholecystectomy in Sarcoidosis Patient
    This video demonstrate Laparoscopic cholecystectomy in Sarcoidosis Patient performed by Dr R K Mishra at World Laparoscopy Hospital. Sarcoidosis is a chronic, granulomatous condition with unknown cause. Because most of the patients are free of clinical symptoms, sarcoidosis should be considered in differential diagnosis if noncaseous granuloma is noted in biopsies, performed for other reasons. With no clinical symptoms, our patient was diagnosed with sarcoidosis upon identifying noncaseous granuloma in the lymph node biopsy material collected during the laparoscopic operation, performed for gallbladder stone. The 20-year-old female patient presented with abdominal pain, which began 10 days ago, and underwent relevant examinations, among which abdominal USG demonstrated a polypoid lesion with a diameter of 5.7 mm in the gallbladder, and laparoscopic cholecystectomy was therefore performed.
  • Laparoscopic Cholecystectomy - Michael Bickford, FRACS
    This video depicts the surgical removal of the gallbladder using laparoscopic methods. This is one of the treatments for gallstones offered by Mr. Michael Bickford.
  • 12 th International Congress of Minimally Invasive techniques & surgeries 9...
    It is great pleasure to invite you to 12th International Congress of Minimally Invasive techniques & surgeries 9-11 November 2016.
    The aim of this congress is to offer a variety of topics covering the continuous developments in the field of Endoscopic surgery. This meeting will focus on Gastric, Colorectal, Biliary, Bariatric, Endocrine, Urological, ENT, Plastic and Gynecological Endoscopic updates.
    I hope this would also be a great opportunity for you to be able to spend some time visiting and enjoying many fascinating and historical sites in Iran such as Isfahan,shiraz and more.
    I am looking forward to seeing and welcoming you in Tehran.

    Professor H.Kalbasi, FRCS (ENg.), FACS.
    President of Association of Iranian Endoscopic Surgeons
    President, Iran Chapter American College of Surgeons
  • Skin to Skin Unnedited Full length Laparoscopic Cholecystectomy
    Most of the laparoscopic cholecystectomy videos present on the net is edited. This video shows Skin to Skin Unnedited Full length Laparoscopic Cholecystectomy performed by Dr. R.K. Mishra at World Laparoscopy Hospital. This video is important for the surgeons who want to learn each and every minute steps of laparoscopic cholecystectomy. There is no cut in this video and it is a real time surgical video of laparoscopic cholecystectomy.
  • Oral glucose tolerance test preferred for pre-diabetes screening in PCOS
    This study found that among PCOS patients, HbA1C and FPG were poor detectors of pre-diabetes and showed limited agreement with the screening standard, the 2-hour oral glucose tolerance test (OGTT). Additionally, pre-diabetes was found in 7% of normal weight PCOS patients. This finding suggests that the current American Diabetes Association (ADA) recommendation of screening only PCOS women with body mass index (BMI) ≥ 25 kg/m2 would miss a substantial portion of pre-diabetes cases. Additionally, the results of this investigation suggest that OGTT should be the screening test of choice for pre-diabetes in PCOS patients, a population a higher risk for Type 2 Diabetes, rather than the current ADA guidelines which recommend diagnosis via FPG, HbA1c or OGTT.

    Strengths include a large sample size, strict definition of PCOS using Rotterdam criteria, evaluation of standard anthropometric data from all subjects and assessment of pre-diabetes through multiple tests. Limitations include a cross-sectional design and a low prevalence of pre-diabetes and T2DM in the study population, who was also younger and leaner (median age 27, median BMI 24) than the average PCOS patient. Reproducibility of results in a more diverse PCOS patient population would confirm study findings and inform management.

    Click to read the study in Human Reproduction

    Relevant Reading: American Diabetes Association: Standards of Medical Care in Diabetes-2013

    In-Depth [cross-sectional study]: This study compared the utility of HbA1C, FPG and the OGTT in identifying pre-diabetes and T2DM in a cohort of 671 Austrian women being evaluated for PCOS from 2006 to 2012. Diagnosis of PCOS was made using the Rotterdam criteria (2 of the 3 following criteria had to be met: clinical or biochemical hyperandrogenism, oligo- or anovulation and sonographic polycystic ovary morphology, defined as ≥12 follicles, 2-9mm in diameter in at least 1 ovary). Pre-diabetes and T2DM were diagnosed using ADA guidelines (elevated FPG and/or HbA1C and/or 2-hour plasma glucose). Standard anthropometric data, hormone levels, serum lipids, HbA1C, FPG and 2-hour OGTT were assessed in all patients.

    HbA1C showed weak agreement with OGTT for diagnosing pre-diabetes (κ 0.36, p<0.001) and had poor sensitivity (25%). Among women whose BMI was <25 kg/m2, sensitivity was even poorer at 4.3%. FPG was also demonstrated weak agreement with OGTT for pre-diabetes diagnosis (κ 0.05, p<0.001) with a sensitivity of 40.8%. When screening for Type 2 Diabetes in contrast to pre-diabetes, results from HbA1C and FPG tests demonstrated higher agreement with OGTT results (κ 0.80, p<0.001 for both) and improved sensitivity (66.7% for both).
  • Postoperative early major and minor complications in laparoscopic vertical sleev...
    The aim of this meta–analysis and systematic review was to compare the “early postoperative complication rate i.e. within 30–days” reported from randomized control trials (RCTs) comparing these two procedures. This meta–analysis and systematic review of RCTs suggests that fewer early major and minor complications are associated with LVSG compared with LRYGB procedure. However, this does not translate into higher readmission rate, reoperation rate, or 30–day mortality for either procedure.
    Methods

    RCTs comparing the early complication rates following LVSG and LRYGB between 2000 and 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database.
    The outcome variables analyzed included 30-day mortality, major and minor complications and interventions required for their management, length of hospital stay, readmission rates, operating time, and conversions from laparoscopic to open procedures.
    Results

    Six RCTs involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on early major complications.
    A statistically significant reduction in relative odds of early major complications favoring the LVSG procedure was noted (p = 0.05).
    Five RCTs representing 633 patients (LVSG n = 317, LRYGB n = 316) reported early minor complications.
    A non-statically significant reduction in relative odds of 29 % favoring the LVSG procedure was observed for early minor complications (p = 0.4).
    However, other outcomes directly related to complications which included reoperation rates, readmission rate, and 30-day mortality rate showed comparable effect size for both surgical procedures.
  • Africa Africa sees first robotic assisted surgery
    The Urology Hospital in Pretoria has successfully conducted Africa’s first robotic assisted removal of a cancerous bladder (cystectomy) and prostate (cysto-prostatectomy).

    Dr Hugo van der Merwe, who performed the surgery, also used the robotic system to reconstruct a new bladder (neobladder) from the patient’s bowel, after removing the cancerous bladder and prostate in what is normally a high morbid surgery.

    “Success using the robotic system has been excellent,” said van der Merwe. “The patient had aggressive bladder cancer and needed standard post-operative chemotherapy. The recovery is remarkable.”

    The 36-year-old patient now has perfect bladder control, is fully potent and enjoys normal bodily functions without the burden of a colostomy bag.

    Van der Merwe added: “Standard surgical procedures are associated with very high morbidity (complication) rates. Even in the best medical centres in the world there is a 30% chance of secondary surgery within the first 30 days after operating as well as significant problem such as blood loss, pneumonia and embolism. The robotic system aids in significantly less morbidity and recovery time is much faster. We have not as yet had to take any patients back to theatre due to complications.”
  • Anggia
  • Gentle C-Sections Rising In Popularity, But Are They Worth The Risk?
    SACRAMENTO (CBS13) — Doctors say a new birth method attempts to bring more closeness, calmness and connection to mothers and their babies.

    The family-centered or gentle C-sections are becoming a new trend at hospitals across the country. They essentially try to mirror a natural birth as much as possible.

    But C-section rates are at nearly 33 percent, which is more than what the World Health Organization set as a target, and some doctors believe it could create unnecessary danger.

    “Some of the most important time is right at the time of delivery for both mom and baby,” said Sutter Health’s Dr. William Gilbert

    What used to leave mothers knocked out on the surgical table has now become a more gentle, inclusive process aimed at instant family bonding.

    “When we throw the baby on the mom’s chest and we prepare the baby and finish the cesarean and keep that baby as close to mom as possible, I think they’re thrilled to realize it’s not as scary as they thought it was going to be,” he said.

    He’s delivered dozens of babies via the gentle C-section method and believes it’s a healthy alternative for those who want a low-intervention birth, but require a Cesarean for medical reasons.

    “As we get more young people who have been exposed to it, who want to bring this type of delivery to the parents, I think you’re going to see more people do it,” he said.

    Instead of cutting the umbilical cord and quickly whisking the baby away to a warmer, the new approach uses the same immediate skin-to-skin contact and early breastfeeding associated with a natural birth.

    But Dr. Elliot Main with the California Maternal Quality Care Collaborative is concerned it could lead to an unnecessary increase in procedures.

    “I think there is some worry about an advertising campaign for a natural or gentle C-section because it can diminish the overall concern for use or overuse of C-sections,” he said.

    There can also be some serious complications down the road, especially for women who have multiple children.

    “One of the most important complications of a C-section is in the next pregnancy or in the next pregnancy after that, the placenta will invade very deeply into the muscle of the uterus. This is called a placenta accreta. That’s a very dangerous condition that often time leads to hysterectomy at the time of the delivery,” he said.

    While both doctors maintain a natural birth is still the best and healthiest way, they continue to brace for a shift in more delivery rooms across the country.
  • Gynecological surgery removal of the uterus
    Total laparoscopic hysterectomy is a safe and effective procedure for women needing a hysterectomy. We enjoy a high operative volume and perform approximately 200 laparoscopic hysterectomy cases annually with a conversion rate of 1 in every 400 cases. The 10 steps described herein are not meant to be an absolute truth, but rather a true and tested method that has served us well to safely accomplish this procedure.

    If the uterus is large and requires manipulation with a tenaculum, consider injecting dilute vasopressin subserosally prior to applying traction to the uterus. This can reduce bleeding associated with pulling and tearing of the uterine serosa.
    In cases with poor exposure, we routinely use sutures to retract organs away from the surgical field. A redundant sigmoid can be retracted by taking a series of bites with a 0 prolene suture through the epiploica and pulling the suture through the lower quadrant port. The port is removed to get the sutures out and then reinserted. The sutures are then secured to the skin with a hemostat. Take care to include a number of epiploica to avoid tearing.
    Alternatively, ovaries or other structures can be tacked away using a 6-inch suture (0 Quill PDO or 0 vicryl) with a LapraTy on the end. The needle is passed through the structure and then a bite is taken through the inside of the anterior abdominal wall. This end of the suture is then secured with another LapraTy and the needle is cut away and removed.
    If access to the uterine vessels is difficult, take the uterine vessels up high initially to secure the blood supply to the upper uterus and then gradually work down, staying medially to the vessels.
    Maintain exposure at all times-do not dig yourself into a hole-always be ready to deal with a sudden onset of bleeding.
    The combination of a prior cesarean delivery and a large uterus is a set up for bladder injury-stay high on the vesicouterine peritoneum, respect any fat that you see, and watch out for air in the Foley balloon.
    In severely distorted anatomy consider entering the retroperitoneum sooner rather than later. The easiest starting point is usually at the round ligament.
  • Laparoscopic meckel's diverticulectomy - Management of Symptomatic Meckel&#...
    This video demonstrate Laparoscopic meckel's diverticulectomy performed by Dr R K Mishra at World Laparoscopy Hospital. Meckel's diverticulum was first described about 400 years ago and continues to be a rare congenital disorder of small intestine. Laparoscopic surgery for Meckel's diverticulum has been described as a safe and effective procedure. We present our this video of patient with symptomatic Meckel's diverticulum. The incidence of Meckel's diverticulum at our institution is 0.3%. The majority of patients were male children. There were no staple-line leaks in any case.

    Laparoscopy is useful in both diagnosis and treatment. Laparoscopic resection of Meckel's diverticulum is feasible and ideal, especially when performed in specialized centers.

    For more videos https://www.laparoscopyhospital.com/DOWNLOADS.HTM
  • Pediatric Laparoscopic Cholecystectomy and Appendectomy in Same Patient by Two P...
    This video demonstrate Pediatric Laparoscopic Cholecystectomy and Appendectomy in same patient by Two Port by Dr R K Mishra at World Laparoscopy Hospital. The laparoscopic appendicectomy can be performed using one to several ports. We present our experience of two port laparoscopic cholecystectomy and appendectomy in pediatric patient. The objective was to assess the results retrospectively in terms of complications and its limitations. From our experience, laparoscopic cholecystectomy and appendicectomy using two reusable ports had good visualization, decreased rate of misdiagnosis and a short hospital stay. Contrary to the general belief, the incidence of port site wound infection was minimal.
    https://www.laparoscopyhospital.com/
  • A tribute to Dr Rakesh Sinha - An Endoscopic Legand
    Dr Rakesh Sinha, a pioneer of laparoscopic gynaecology in India, succumbed to a heart attack on Monday morning during a walk at Bandra. Dr Sinha collapsed while he was preparing for the Mumbai Marathon 2016 and was declared dead at Holy Family Hospital, Bandra at 9.30am. He is survived by a son, daughter and his wife - all three are doctors.
  • Bilateral TAPP Inguinal Hernia Surgery
    https://www.youtube.com/watch?v=lwwPaZBC4e0&feature=youtu.be
    This video demonstrate Bilateral Transabdominal Preperitonial Laparoscopic Inguinal Hernia Surgery Performed by Dr R K Mishra at World Laparoscopy Hospital. Laparoscopic inguinal hernia repair originated in the early 1990s as laparoscopy gained a foothold in general surgery. Inguinal hernias account for 75% of all abdominal wall hernias, and with a lifetime risk of 27% in men and 3% in women. Repair of these hernias is one of the most commonly performed surgical procedures in the world. In the United States, approximately 800,000 inguinal herniorrhaphies are performed annually. https://www.laparoscopyhospital.com
  • Happy New Year!
    We hope that in this year to come, you make mistakes. Because if you are making mistakes, then you are making new things, trying new things, learning, living, pushing yourself, changing yourself, changing your world. You're doing things you've never done before, and more importantly, you're doing something.
  • Gordian Surgical Clinical Trials
    This all-in-one device thus provides a secure fascia closure that simplifies and improves laparoscopic procedures. It requires only minimal training, and saves both physician and operating room (OR) time, and also facilitates closing ports that are not currently sutured due to their technical complexity. The device is compatible with all types of trocars: bladed/bladeless, disposable/multiuse, and others. The TroClose1200 is a product of Gordian Surgical (Misgav, Israel), and has been approved by the U.S. Food and Drug Administration (FDA).
  • Laparoscopic adjustable gastric banding. Standard procedure with step-by-step co...
    Our technique for lap banding. Obesity surgery.
  • Laparoscopic Perforation repair
  • Track Recurrence After Robotic Transaxillary Thyroidectomy; A Case Report Highli... (ncbi.nlm.nih.gov)
    Thyroid. 2016 Feb 5. [Epub ahead of print]
    • Dr Sohail Bakkar Prof. at University Hospital of Pisa, Pisa-Italy. Hashemite University (Jordan) I hope to follow in your foot steps
    • Dr. R. K. Mishra Director at World Laparoscopy Hospital Wonderful. The way you are publishing article you will create a record. I am proud of you. Track Recurrence After Robotic Transaxillary Thyroidectomy; A Case Report Highlighting The Importance of Controlled Surgical Indications and Addressing Unprecedented Complications. Wow...
  • Doing right by your patients — Dr. Deborah Keller sheds light on laparoscopic co...
    Despite minimally invasive surgery yielding countless benefits for patients, many physicians are hesitant to adopt the techniques over more conservative options.

    Deborah S. Keller, MD, a surgeon practicing at Colorectal Surgical Associates in Houston, conducted a study analyzing both the clinical benefits and cost savings laparoscopic colectomy offers patients compared to open surgery. Her study, published recently in Surgical Endoscopy, found laparoscopy yielded more than $3,200 in cost savings per patient. The total cost for laparoscopy was $17,268, significantly less than open surgery — $20,552. Minimally invasive surgery yields a potential cost savings of nearly $20 million in healthcare utilization over a one-year period.

    In addition to the cost savings, MIS also provides patients enhanced clinical outcomes. Dr. Keller and her colleagues found patients who underwent MIS were 24 percent less likely to be readmitted, 44 percent less likely to suffer a complication and 58 percent less likely to experience mortality than patients who underwent open surgery.

    "Patients need to know that when feasible, laparoscopic colectomy is the gold standard," Dr. Keller says.

    With more evidence proving the effectiveness of MIS, more medical professionals are adopting the technology, but there is room for growth. In her study, "The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes," Dr. Keller and her fellow researchers found less than 5 percent of urgent and emergent colectomies in the United States are performed laparoscopically.

    While many surgeons are aware of MIS' effectiveness, they may feel open surgery is a safer option in emergent cases, which Dr. Keller explains is not always the case.

    "Surgeons can always start a procedure laparoscopically and can convert to open surgery in a matter of seconds, if needed," Dr. Keller says. "If patients can handle laparoscopic surgery, the benefits are immeasurable."

    Surgeons can also learn these techniques through the different classes that various hospitals and device companies offer. As patients becoming increasingly savvy and aware of the latest and greatest techniques, the surgeons that provide the least invasive techniques may prove a more attractive option for patients. Many patients, however, wholly trust their physician and will trust his/her expertise regarding the best treatment option.

    "There is a learning curve, especially given the time commitment to learn the procedures," Dr. Keller says. "Yet, it is our duty as physicians to do the best thing for our patients and offer these MIS techniques."
  • Laparoscopic neovagina creation
    A neovagina was created by a laparoscopic modification of Vecchietti's operation in two women with Mayer-Rokitansky-Küster-Hauser syndrome. A plastic olive was applied to the vaginal dimple and pulled upward by two threads passed through the potential neovaginal space at laparoscopy, without the need for laparotomy or dissection of the vesicorectal space. In both cases we obtained very good results in anatomic and sexual functional terms.
  • Laparoscopic Rectopexy
    Authors: Joseph W. Nunoo-Mensah, FRCS; Jonathan Efron, MD, FACS; Tonia Young-Fadok, MD, MS, FACS