February 1995
RESEARCHERS SAY LAPAROSCOPIC APPENDECTOMY IS "PROCEDURE OF CHOICE" . . .
A recent study by Frazee et al. (Annals of Surgery, 1994) confirmed the safety and efficacy of laparoscopic appendectomy. The study compared results from 75 patients who were randomly assigned either to laparoscopic appendectomies (37) or to the open procedure (38). Two patients were converted during surgery from the laparoscopic to the open procedure.
Results show the laparoscopic approach can be performed in a high percentage of patients, even in cases of perforation, with a significant reduction in postoperative pain. In addition, patients who had laparoscopic appendectomies resumed full activities 14 days after surgery, whereas patients who underwent open appendectomies did not resume normal activities for an average of 25 days. The authors conclude that "laparoscopic appendectomy is the procedure of choice for patients with suspected acute appendicitis."
. . . WHILE FORMER VICE PRESIDENT QUAYLE CHOOSES LAPAROSCOPIC APPROACH
Former Vice President Dan Quayle became one of the most famous patients to undergo laparoscopic surgery when he had his appendix removed in January. Mr. Quayle elected to have the minimally invasive procedure after a CAT scan detected an enlarged appendix during a hospitalization in December. The former Vice President was comfortable and in good humor following surgery and was reported to be recovering well.
LAPAROSCOPY REDUCES RECOVERY TIME, COSTS FOR REMOVING TUBES & OVARIES
A study by Pittaway et al. comparing laparoscopic adnexal excision with conventional laparotomy (open abdominal surgery) for the removal of the fallopian tubes and ovaries found that the laparoscopic approach offered significant advantages, including faster operating time, shorter hospitalization and recovery time and reduced hospital costs.
In the study (American Journal of Obstetrics and Gynecology, August 1994), which compared 64 women who underwent the laparoscopic approach with 26 women who underwent traditional laparotomy, findings included a reduction in mean operating time (107 minutes open vs. 88 minutes laparoscopic), with an average hospital stay of 1 day for laparoscopic patients vs. 3 days for traditional patients. Average recovery time was 1 week in the laparoscopic group, while the open group had a significantly longer recovery of 4 weeks. In addition, the laparoscopic approach reduced the average total cost by $1,471 ($4,573 laparoscopic vs. $6,044 open).
STUDY SHOWS LAPAROSCOPIC-ASSISTED COLECTOMIES ARE SAFE AND EFFECTIVE
A study by Hoffman et al. comparing 80 consecutive patients who underwent laparoscopic-assisted colectomies (the removal of a segment of colon), with a group of 53 patients who underwent standard open colectomies concluded that laparoscopic-assisted colectomies can be performed safely and effectively with minimal complications when approached by an experienced surgical team.
The study (Annals of Surgery, June 1994) included different types of colectomies performed for a variety of conditions. The researchers reported the following advantages associated with the laparoscopic technique: reduced pain, earlier return to normal physiologic state, faster return of gastrointestinal function and a shortened average hospital stay (5.2 days vs. 7.8 days). In addition, researchers noted that the average operating time for laparoscopic and open procedures was the same (185 and 183 minutes respectively) after surgeons gained experience with laparoscopic techniques.
VIDEO ASSISTED BIOPSY FOR RARE LUNG DISEASE EFFECTIVE, LESS PAINFUL
Video assisted thoracic surgery (VATS) now provides surgeons with an accurate, less-traumatic way to diagnosis lymphangioleiomyomatosis (LAM), a rare pulmonary disease that afflicts young women of childbearing age.
Symptoms of LAM, which include labored breathing and spontaneous pneumothorax (collapsed lung), result from the rapid reproduction of immature muscle throughout the tissue surrounding bronchi (two main air passageways leading from the trachea to the lungs), blood vessels and lymphatic vessels. Most patients diagnosed with LAM die within 10 years from progressive deterioration of lung function. Because of the implications of the disease, an open lung biopsy is done to ensure accurate diagnosis, which requires a long, painful incision and the ribs to be cut or spread.
Dr. William H. Johnson of Ormond Beach, FL, says these patients no longer have to endure the pain of an open lung biopsy because video assisted techniques now enable surgeons to perform the same diagnostic test in a minimally invasive manner. Dr. Johnson recently performed a video assisted lung biopsy on a 31-year-old patient who had been experiencing spontaneous pneumothorax. "The video assisted approach allowed for accurate diagnosis of LAM without the pain associated with the traditional open diagnostic approach," Dr. Johnson said.
PATIENT INFORMATION ON LUNG & HEARTBURN SURGERY NOW AVAILABLE
Informational brochures on video assisted lung surgery and laparoscopic heartburn surgery are available from United States Surgical Corporation. A video news package and information kit on laparoscopic heartburn surgery are also available. Call Susan Thiele at 203-845-1735.
For more information or copies of references cited, please call Steve Rose, Editor, at 203-845-1732. The Laparoscopy Report is a trademark of United States Surgical Corporation.
