M I N I - L A P
CASE SELECTION
Mini-Lap's Many Applications
LEARNING CURVE Surgeons need to build their mini-lap skills before tackling the more challenging cases.
Surgeons skilled at mini-lap can apply it during any abdominal surgery, including difficult cases such as bariatric and colon procedures. But the technique isn't necessarily
suitable for all surgeons — physicians who don't focus on the approach will likely have a difficult time incorporating smaller tools into their standard instrument sets.
Most general surgeons interested in adding mini-lap will adapt to the technique easiest during lap choles, appendectomies, small bowel work, or removal of the ovaries (particularly the BRCA ovary removed prophylactically) or a small uterus (the bigger the uterus, the harder it is to hold with thin instrumentation). Adrenalectomies can also be done with mini-lap techniques, but to control the local blood vessels during the procedure, surgeons must insert a 5mm trocar to accommodate a clip applier or tissue sealing device, neither of which is yet
available or truly effective in 3mm sizes.
Be aware that operating on the kidneys, pancreas, colon and stomach is more challenging with mini-lap techniques.
— Paul G. Curcillo II, MD, FACS
Instrument upgrades
The mini-lap movement is going to take some time before it gains widespread traction. The instruments need to get a bit stronger and handle designs need to evolve fully from tools that let surgeons push and pull to devices that let them grasp and maneuver, so they can operate without altering their preferred techniques. During one of my recent thickened and inflamed gallbladder removals that proved challenging, for example, using mini-lap instruments wasn't an effective
