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to do operative work."
Dr. Nezhat has been able to per-
form procedures on patients for
which previous conventional
laparoscopy and open surgery
attempts have been unsuccessful.
With the mini-laparoscopy instru-
ments, he has successfully treated
severe endometriosis, including
invasion to the bladder and ureter.
He's performed hysterectomies and
bowel procedures. He's also
removed adhesions, large tumors and mesh embedded in organs.
3. What about high-acuity
procedures?
Mini-lap instruments don't have the type of dexterity for
gastric bypass, says the industry rep. "The intended use is for simple tissue
manipulation," he says. The bigger the organ, the harder it is to hold with thin
instrumentation. Ms. Dennis says mini-lap's smaller working jaws don't "take as
big a bite," which not only limits procedures you can do, but could also prolong
cases and force surgeons to alter their preferred techniques. Then there's the
question of whether the tools are sturdy enough. "When going through a tiny
port, they're not as stable as large instruments. They're fragile and can break,"
says Ms. Dennis. The thinner instruments aren't as strong as standard 5mm
tools, and the graspers and dissectors on the ends of very fine tools aren't ideal-
ly suited for moving thick tissue or anatomy, says Dr. Curcillo. "You can pull
most anything with a mini-lap instrument," he says, "but you can't always push
tissue of significant weight."
Instrument manufacturers are reacting to the growing popularity of mini-lap
with promising designs, including 3mm instruments that snap into standard
S U R G I C A L I N S T R U M E N T S
Thinner instrumentation lets
surgeons manipulate tissue through
smaller holes and improves their
access to the abdominal cavity for
faster and safer surgeries.
T.W.
Meyer
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