From the 43rd AAGL Global Congress on Minimally Invasive Gynecology, being held this week in Vancouver, K. Anthony Shibley, MD, from Fairview Ridges Hospital in Minneapolis, MN, offered ObGyn.net his insight on the various benefits of some of the newer technology in minimally invasive gynecological surgery. Here are his thoughts on 3D technology, the best candidates for LESS, and dual-function instruments.
Q: If a doctor or department head was going to request the hospital or surgical facility to invest in 3D technology, what would be the best reasoning to do so?
Dr Shibley: Laparoscopy has magnification benefits over open surgery but lacks 3D. With 3D laparoscopy, such as with the Olympus ENDOEYE FLEX 3D, for example, we’re restored to the full binocular vision, and it’s a more affordable way to get the advantages of 3D than by integrating it into a robotic platform. So the best reason to invest involves both the desire to provide better surgery and a concern for cost-containment.
Q: LESS is a great option in terms of cosmetic results, but which patients are the best candidates for this particular surgical approach?
Dr Shibley: Simple answer: Almost any patient you’re thinking about for laparoscopy you can think of for LESS. With single port placement at the umbilicus, I don’t have to place trocars around the patient’s pathology. Trocar placement can be one of the challenges in multiport surgery. The single umbilicus entry-point occurs in the thinnest place in the abdomen, allowing an entry that is safe, quick, and under direct vision. This location in the abdomen also allows for much easier access to the patient’s pathology. The learning curve for LESS is slower at the beginning, but then it gets really steep as you move into more advanced procedures. This allows surgeons to treat more difficult pathology and, ultimately, to offer more minimally invasive surgical options for their patients.
Q: What are the benefits of products with dual functions (such as THUNDERBEAT's cut and seal technology) to surgeons? And to patients?
Dr Shibley: The benefit of dual functions, aside from the obvious cost savings, is that I don’t have to make as many instrument exchanges. With a fine dissector and robust vessel sealer in one instrument, I can seamlessly switch from dissector to hemostasis capabilities – and THUNDERBEAT’s sealing capability is the fastest I’ve encountered. I’ve seen this reduce blood loss and time spent in the OR. The hospitals are judging the physicians on cost-containment, so the more efficiencies I can find in my tools, the better. The patients appreciate the cosmetic benefits of laparoscopy, and they may notice that their surgery and healing time goes more quickly.