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A B D O M I N A L
S U R G E R Y
cases, but we don't yet have the long-term clinical trials to draw definitive conclusions.
An accessory for assistance
The exhibit halls at recent general surgery conferences have seen the
introduction of a handful of laparoscopic devices that offer assistance
in the insertion and positioning of mesh. I consulted on the development of one of the earliest such devices. Vendors often distribute
them as loss leaders, discounting their cost in order to get their mesh
products (for which they're specifically designed) onto supply room
shelves.
The question is, do they really help surgeons place mesh faster and
more accurately? Especially since mesh can be implanted without
special tools, and since the purchase of single-use devices can add to
case costs.
Consider this, though: A hernia surgeon's study timed each step in a
series of laparoscopic ventral hernia repair surgeries. On average,
mesh deployment took the most time to accomplish, at about 20 minutes. OR time is priced at about $60 to $80 a minute. If you could
shorten that 20 minutes, repeatedly, you'd probably save a lot in case
costs.
Plus, while these positioning devices were originally seen as aids to
smooth out the learning curve, they even decrease the time it takes
experienced hands to complete the task. Overall, they stand to play a
useful role.
Given this wide array of features, how are we to choose the right
mesh for a particular patient and case? Herniologists like me study
that subject in depth. For the community general surgeon, though, the
decision is largely made through their training, technique and experience, but also through the advice of manufacturers' representatives.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2013
