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Question: Why has laparoscopy become the standard of care for cholecystectomy, whereas in bowel procedures there is a resistance to learn the newer techniques? Q & A
Dr. George Hoffman: You have to take into consideration that these procedures are a lot harder to do laparoscopically than they are open. Most surgeons my age don't want to relearn techniques that they have been doing for years. It can be very intimidating learning to use the cameras and the computer equipment. Some prefer to leave it to the younger people.
Dr. Garth Ballantyne: There is no great patient demand for these procedures. The public knows about the gallbladder surgery because almost everybody who does that procedure routinely now does it with a scope. People who are going in for colon procedures are not being told they have a choice. Most of our patient population is older and unaware of the new technologies that are available. If patients started demanding that we do these procedures, then I think you would see a big increase in the number of surgeons who would want to learn to do them.
Dr. Richard Whelan: I think some surgeons still aren't convinced that these techniques are proven enough yet. There are a lot of critics out there who point to the port-site recurrences as a reason to avoid doing this surgery, but laparoscopy is the way to go and I think it's the best thing out there for our patients. We are doing everything we can right now to try to improve our results and to learn everything we can about how the physiology is affected during these procedures. We are participating in the trials and following the strictest protocols possible. In the end, we are going to overcome the skepticism and prove, through good science, that this technique works and should be used routinely.
Question: How long will it take before enough data on laparoscopic colectomy is in to convince the medical establishment that it is as acceptable as the open technique?
Dr. Joseph Uddo: It's going to be at least five more years before we have the results in from the trials, and even then people are going to still question it. But within five years we will have done randomized, controlled trials, and I think we will show that laparoscopy is as good as, if not better than, open surgery for bowel procedures.
Dr. Whelan: It's much too early to say when we can "prove" that laparoscopy is better. I think it will happen, but none of us can say for sure how much longer it is going to be. We know that there are still a lot of unresolved issues. Until we clarify those issues by participating in the trials and putting our data out there for others to see it, we are not going to be able to make the kind of convincing argument for laparoscopic colectomy that we need to make.
Vol 3 No 2 Fall 1995
Medical Editors:
Dr. William Kelley, Jr.
Dr. Douglas Olsen
Dr. Joseph Petelin
Editorial Director, Special Projects:
James Prudden
Principal Writer:
Laura A. McKeown
Creative Director:
Michele Velle, MAX Graphics
Art Director:
Frank Tagarello, MAX Graphics
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James O'Neill
Designer:
Oksana Olkovetsky
Copy Editor:
Christopher Davis
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Copyright © 1995 by Laparoscopy in Focus. Sponsored by an educational grant from United States Surgical Corporation.
The opinions expressed herein are those of the writers and interviewees and are not necessarily those of the publisher or sponsor.
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