January 1997
PATIENT BENEFITS, COST SAVINGS REPORTED AS MIS EXPANDS TO NEUROSURGERY
New instruments that allow neurosurgeons to navigate through the brain
with more precision than traditional devices result in less trauma for
patients, shorter hospitals stays and significant cost savings, researchers
report.
According to a recent article in Chirurgia International, devices
typically used in minimally invasive surgery are being adapted for neurosurgery.
Endoscopes are now made in miniature sizes and are more flexible, making
them the instrument of choice for a variety of neurological procedures.
Advanced video systems and laser equipment have also been adapted for this
specialty.
Neuroendoscopy, like laparoscopy, involves a very small opening through
which a fiber optic scope is inserted. In the case of neurosurgery, the
scope is only 4 millimeters (less than a quarter inch) in diameter. Unlike
the traditional procedure, which involves cutting away a portion of the
skull bone, surgeons use a much smaller incision, leading to less operating
time, a shorter hospital stay and a quicker recovery.
At the University of Mississippi Medical Center in Jackson, for example,
surgeons report removing a non-malignant brain tumor from a 63 year-old
woman. The procedure, which would have typically required about 8 hours
and a week-long hospital stay, was successfully completed in just 2 hours,
followed by a 1-night hospital stay. Researchers say these procedures result
in better patient outcomes, fewer complications and a one-third reduction
in physician and hospital related charges.
NEW TECHNOLOGY INCREASES SAFETY, REDUCES COSTS FOR REMOVAL OF PELVIC
MASSES
Researchers report that recent advances in laparoscopic instrumentation
increases safety and reduces costs for patients undergoing laparoscopic
colpotomy -- the removal of pelvic masses through the vagina.
By combining an endoscopic light source (Pelosi Illuminator**, Apple Medical
Corporation, Bolton. MA) with the cutting and visual capabilities of the
VISIPORT* optical trocar system (United States Surgical Corporation, Norwalk,
CT), doctors at Pelosi Women's Medical Center, Bayonne, NJ, have been able
to perform a true visually guided, laparoscopic cul-de-sac entry through
the vagina.
"Because of the VISIPORT*'s cutting mechanism, it requires less insertion
force than standard blind trocars," says Dr. Marco A. Pelosi, inventor
of the Pelosi Illuminator** along with his son Marco A. Pelosi, III. "As
a result, there is less chance of accidentally injuring vascular and cystic
structures. In addition, VISIPORT* can also accommodate the Pelosi Illuminator**,
which lights the cul-de-sac as the cutting mechanism passes through. This
helps reduce the chance of injury to surrounding structures and eliminates
the expense of an additional laparoscope," Dr. Pelosi concludes.
An article describing the technique in 35 patients will appear in an issue
of The Journal of Reproductive Medicine in the near future.
LAPAROSCOPY OFFERS COST-EFFECTIVE TREATMENT FOR ESOPHAGEAL ACHALASIA
A recent study by Ancona et al. (The American Journal of Surgery) found
that laparoscopic surgery is preferable to a traditional "open"
approach when treating esophageal achalasia, a condition in which the esophagus
cannot properly relax, making swallowing difficult.
Surgical correction--called the Heller-Dor procedure--involves reducing
the resistance of the lower esophageal sphincter, a circular band of muscles
that acts as a valve between the esophagus and the stomach.
The study compares the experience of 34 patients who underwent a Heller-Dor
procedure at the University of Padua (Padua, Italy). Researches report
that while laparoscopic and traditional surgery have comparable short-term
results, patients who underwent laparoscopic surgery (17) saved an average
of $383. Although instrumentation costs were higher in these cases, researchers
attribute their cost savings to a shorter average hospital stay of 4 days
vs. 10 days with traditional surgery. In addition, laparoscopic patients
returned to normal activities an average of 2 weeks earlier than traditional
patients, leading researchers to conclude that overall savings would be
higher if productivity gains were considered.
"The cost-benefit analysis of surgical procedures for esophageal achalasia
will lead to the laparoscopic Heller-Dor being considered the most viable
and cost-effective alternative to the open technique," the study concludes.
LAPAROSCOPIC SPLENECTOMY PROMISING FOR CHILDREN AND ADULTS WITH ITP
According to a recent article in Laparoscopic Surgery Update,
surgeons from around the world are now recommending laparoscopic splenectomy
for children and adults suffering from idiopathetic thromobocytopenic purpura
(ITP), a disorder involving hemorrhaging that is marked by a reduction
of blood platelets.
Dr. Oded Zamir reports good results after performing the procedure on 8
patients at Hadassah University Hospital in Jerusalem, Israel. All patients
recovered without complications, required minimal pain medication and had
increased platelet counts within 15 months postoperatively. Similar results
were reported in Germany and Japan, where, along with ITP patients, laparoscopic
splenectomy was used to treat children and adults with Hodgkin's Disease,
a hereditary disorder and abnormally low platelets associated with HIV
or hairy cell leukemia.
