May 1995
MCGRAW HILL: FAST RECOVERY FROM LESS-INVASIVE SURGERY SAVES ECONOMY $2 BILLION . . .
Three of the most common minimally invasive surgical procedures offer the U.S. economy a potential savings of $1.9 billion annually, according to a newly released study by DRI/McGraw Hill. Funded by the Health Care Technology Institute, a health policy research organization, the study found that the indirect benefits of laparoscopic gallbladder removal save approximately $1.2 billion annually, while laparoscopic hysterectomy and laparoscopic hernia repair save $500 million and $200 million respectively.
These estimates are based on the number of traditional -- or open -- gallbladder, hysterectomy and hernia repair procedures performed from 1988 to 1991 that could have been performed in a less-invasive manner. The study defines the indirect benefits of less-invasive surgery as increased productivity from a patient's rapid recovery and quicker return to work.
Noting that the benefits of minimally invasive procedures to the overall economy can be substantial, the researchers caution that trying to determine the impact of new technologies based on health care costs alone can be misleading. "As the nation focuses on controlling those factors that contribute to the rising costs of health care, one critical element of the debate is often overlooked -- the total economic benefits derived through health care technology . . . Without accounting for indirect benefits, the net benefits of a given technology cannot be assessed accurately," the study concludes.
SECOND OPINION: DOCTOR AS PATIENT SAYS LAPAROSCOPY A 'BOON' FOR SELF-EMPLOYED
Dr. Catherine Coleman knows first-hand about both the patient and economic benefits of laparoscopic surgery. At about the time when most patients would just be getting back to normal activities from "open" surgery, Dr. Coleman was checking into the hospital for her second major operation in less than 2 months. Because of the shorter recovery period associated with laparoscopy, Dr. Coleman was able to undergo gallbladder surgery just 7 weeks after a laparoscopic procedure for heartburn.
"Laparoscopy is definitely a boon for those who are self employed," said Dr. Coleman, "I could have been out of work for months but I only lost 4 days of work between both procedures."
Dr. Coleman, an obstetrician and gynecologist who practices alone in Wheeling, West Virginia, had been managing her severe heartburn with medication before deciding on surgery. "I'm only 45-years-old and I didn't want to be taking medication for the rest of my life," says Dr. Coleman. "I knew I had to have surgery because I couldn't stop taking the drugs without experiencing pain." After extensive research, Dr. Coleman decided to undergo laparoscopic Nissen fundoplication, a procedure that strengthens the valve between the stomach and the esophagus. She was discharged from the hospital 3 days after surgery and was back in the office seeing patients within a week. And for the first time in more than a year, her heartburn problems were over.
But 4 weeks later, Dr. Coleman began having problems with her gallbladder. So she went back to the surgeon who performed her first procedure, Dr. David Ghaphery, also of Wheeling, WV. Again, Dr. Ghaphery suggested laparoscopic surgery. Dr. Coleman returned home one day after having her gallbladder removed and was back in the office 2 days later. "What made Dr. Coleman's gallbladder surgery unique," says Dr. Ghaphery, "is being able to see how well she healed internally from her first operation. When I looked into her belly with the scope the second time, I couldn't tell that she had previous surgery. One of the advantages of laparoscopic surgery is the decrease in trauma, resulting in less adhesions (scarring) in the abdomen. This was the first opportunity I've had to actually see this for myself."
LAPAROSCOPY OFFERS EXCELLENT RESULTS FOR HEARTBURN SUFFERERS
A study of 70 patients by Pitcher et al. (Contemporary Surgery, December 1994) found that laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease (GERD), a condition in which stomach acids surge upward into the esophagus causing severe heartburn and other symptoms.
All patients underwent the laparoscopic procedure after an intensive medical regimen -- including dietary changes and extensive drug therapy -- failed. Of the 70 patients, 68 were completed laparoscopically with 2 conversions to the open procedure. Researchers found the laparoscopic approach provided better visualization, a shorter hospital stay (average = 3 days) and a faster return to normal activities (average = 7 days). A follow-up period of 8 months showed complete relief of heartburn, regurgitation and other symptoms attributable to GERD.
NEW LAPAROSCOPIC TECHNIQUE ALLOWS HERNIA REPAIR WITH LOCAL ANESTHESIA
Researchers report that a new laparoscopic technique allows surgeons to repair hernias without entering the abdominal cavity, which eliminates the need for general anesthesia for many patients. The technique involves a new "balloon" dissection device (Spacemaker Balloon Dissector, General Surgical Innovation, Palo Alto, CA) that separates the layers of tissue between the skin and the abdominal wall, providing surgeons with access to the hernia site.
Of the 113 cases studied by Kieturakis et al. (American Journal of Surgery, December 1994), all were performed on an out-patient bases and approximately 30% were performed under local anesthesia. Nearly 60% of the patients returned to work -- and nearly 40% were engaged in heavy lifting or sports -- within 2 weeks. More than 80% of the patients had only minimal irritation or discomfort 3 days after surgery. The researchers conclude that balloon dissection is a safe and effective technique that combines the benefits of laparoscopic hernia repair (less pain, faster recovery) with the benefits of open hernia surgery (avoiding penetration of the abdominal cavity, use of local anesthesia).
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.
