From the 16th SLS Annual Meeting and Endo Expo 2007, San Francisco, California, September 5–8, 2007
Laparoscopy updates are presented at SLS Annual Meetings by members of SLS’ Special Interest Group (SIG) Committees. SIG committee members support the educational mission of SLS through prearation of the updates as well as preparing “Patient Information Pages. ” Learn more at www.SLS.org.
The Winners and Losers: Urologic Update in Minimally Invasive Surgery 2007
Presented by Howard Winfield, MD
Over the past 15 years, almost every type of abdominal or pelvic surgery has been tried laparoscopically or robotically. Which of these procedures have proven to be better than the open procedure (the winners) and which have proven to be worse (the losers)? Laparoscopic radical, simple and donor nephrectomy and laparoscopic adrenalectomy are winners and have become the gold standard. Patients have a better postoperative outcome and the end points of cancer cure or removal of the disease organ are equal to that of open surgery. Robotic-assisted radical prostatectomy for prostate cancer is a winner, being as good as or better than the open procedure in terms of blood loss, continence, hospitalization, and convalescence. In 2007, it is estimated that over 50% of radical prostatectomies will be done robotically. Some losers include laparoscopic partial nephrectomy, radical cystectomy and urinary diversion, ureterolysis for retroperitoneal fibrosis, and retroperitoneal lymph node dissection for testis tumor, which have not been shown to be better than the open procedures. Laparoscopic varix ligation for treatment of varicoceles and bladder neck suspension for female stress urinary incontinence are not as good as microsurgical varix ligation and transvaginal bladder suspension. As for pediatric laparoscopic and robotic procedures, they are still developing and have little strong support among practitioners.
Update Abdominal and Pelvic Pain and Adhesions
Does Adhesion Cause Pain? Should We Perform Adhesiolysis for Treatment of
Presented by Maurice K. Chung, MD
Adhesions, fibrous tissues connecting organs that are normally separated, cause infertility, chronic pelvic pain, small bowel obstruction, and intraoperative complications, all of which generally lead to subsequent surgery. Pelvic adhesions are very common after pelvic surgery. If adhesions to the peritoneum are mobile, pain is more frequent, but when adhesions are fixed, no pain is experienced. Pelvic adhesions exist in 15% to 45% of patients with chronic pelvic pain; however they may or may not be the cause of the pain. Treatment of adhesions is controversial because surgery may cause the formation of more adhesions. Adhesiolysis decreases pain, but many patients experience a recurrence over time. In a study of 105 patients with previous abdominal surgeries, 50% (52) had adhesions on second look, and 52% (27) had pelvic pain. Twenty of the 27, however, had a positive potassium sensitivity test (74%) and 2 had a positive cystoscopy/ hydrodistention (7.4%), indicating painful bladder syndrome. After treatment for IC/PBS, the pain stopped or decreased by at least 50%.
The Role of Laparoscopy and Robotics in Hysterectomy
Presented by Ceana Nezhat, MD
The rate of hysterectomies performed has remained stable for the past 2 decades, but the number of laparoscopic and laparoscopic-assisted vaginal hysterectomies has doubled. Laparoscopy is being used more frequently in complicated hysterectomies in patients with malignancy. Instruments are being improved that will decrease OR time, reduce morbidity and patient recovery time, and will advance minimally invasive hysterectomies. With progress in radio frequency technology, advances are being made in vessel sealing devices. These new devices allow quick sealing of uterine vessels and ligaments with little tissue damage and charring, thus decreasing OR time, blood loss, and recovery time. Robotic surgery has made laparoscopy even more advantageous because of the improved physical comfort for the surgeon, better visualization with 3-D images and magnification, and instrumentation that corrects for hand tremor and allows better access. Some drawbacks to robotic surgery, however, are expensive equipment, lack of tactile feedback for the surgeon, and increased preparation time and staff training.