Dr. Curcillo: There is a spectrum of laparoscopic surgeons using the
technology. Some who use mini-lap exclusively, and then there are
those who won't touch it. I think most fall in between and see it as
another skill available for select cases.
Which procedures are good matches for mini-lap?
Dr. Novitsky: Mini-laparoscopy is fairly common in tubal ligations and
other GYN procedures, as well as in cholecystectomies, appendec-
tomies and select intestinal procedures. I wish it was used in more
general surgery cases, like inguinal hernia repair, since it's much less
invasive to the abdomen.
Dr. Curcillo: Colorectal and bariatric surgeons are also trying to get
into it, though that's more of a challenge since the small instruments
are hard to use on those who are obese or who have a lot of disease
present. I typically perform single-port surgery, but when that isn't an
option, I'll do a reduced-port procedure. If I'm doing a gallbladder
through the belly button, but I can't quite maneuver it how I need to,
I'll insert a 3 mm instrument percutaneously to assist me. This limits
scarring while still giving me the help I need from an additional entry
point.
Dr. Reardon: We use it as both an addition and an alternative to conven-
tional laparoscopy. It depends on the case. For a surgery that doesn't
require you to remove a specimen, insert a device (like mesh) or use a
stapler, you can do the entire case through 2 mm or 3 mm ports.
Otherwise, you can have 1 or 2 larger (5 to 12 mm) ports and just con-
vert the secondary ones to mini ports. We recently added bariatric cases
and use a 12 mm port for the stapler, a 5 mm port for the camera and 3
3-mm ports for the instruments.
1 1 3
D E C E M B E R 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
