Lone contraindication
We may someday get to where we can do incisionless surgery — where
we'll simply use directive energy sources. Until then, we're going to need
some sort of access to the abdomen. One of the next steps is likely to be
robotic mini-lap. Companies are beginning to mold robots to be able to
use mini instruments. Once that happens, it's going to be a no-brainer.
Everybody's going to realize how easy it is to do these procedures.
Visualization is also getting better. We still usually use 5 mm laparo-
scopes when we go through the abdomen, and we use mini instru-
ments outside the abdomen. But once the optics get better for the 2
or 3 mm laparoscopes, everyone is going to want to use them. The
smaller articulating instruments are also going to be more flexible,
like snakes that can flex in and out of small spaces.
The only real contraindication to mini-lap is lack of knowledge. A lit-
tle additional education is required, not just for the surgeon, but for the
OR staff, too. People need to learn where to place instruments such
that they'll have the best possible access to the surgical site. But it's a
matter of tweaking, not a matter of having to learn an entirely new
approach. That's where the Society of Laparoendoscopic Surgeons
(sls.org) and other societies come into play. We have programs and
courses that help people learn how to use the newer instruments.
We should be doing mini-lap whenever we can. It's what our
patients want, something I'm reminded of whenever the nurses in
our hospital need a gallbladder out or some other kind of abdominal
surgery. They always come and see me, because they know I'm
going to use mini instruments whenever possible. And afterward,
they love showing off their surgeries, or the lack of evidence there-
of, to their friends.
OSM
6 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 6
Dr. Redan (jarlap07@gmail.com) is the immediate past president of the Society
of Laparoendoscopic Surgeons, a professor of surgery at the University of Central
Florida in Orlando and medical director of minimally invasive general surgery
at Florida Hospital-Celebration Health in Celebration.
