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more articles by Mecenas, John A , MD  |  author's bio

The Advantages of Minimally Invasive Surgery

 By John Mecenas, MD


The majority of surgery today involves the use of minimally invasive (laparoscopic) techniques. For patients, this approach to surgery typically means smaller incisions, less pain following surgery, and fewer respiratory complications. By making smaller incisions, we decrease the amount of surgical trauma to the patient. The body’s physiology is not altered in the same way as with open surgery, recovery is usually much shorter, and patients experience a faster return to normal activities.


How does laparoscopic surgery work?


For decades surgeons have used little telescopic lenses to look directly into the abdomen. Over the years, advances in fiber-optics, video, and digital video have improved the ability of surgeons to see inside the body much more clearly. We use carbon dioxide gas to raise the abdominal wall away from the organs, in order to operate inside the abdomen without a large surgical incision.


Through tiny cuts we insert long, narrow tubes called “ports.” Specially designed surgical instruments that fit into the ports are used to operate inside the abdomen while the surgeon views the surgical area on a video monitor. A tiny video camera inside the body projects the images appearing on the monitor.


When is laparoscopic surgery the best option?


Minimally invasive surgery is especially advantageous for procedures where you don’t have to remove something large or where the surgery involves a small organ deep within the body, such as the appendix or the gall bladder. These little organs are hard to get to and operating on them used to require a big incision; laparoscopic surgery has changed that dramatically.


Laparoscopic techniques are also advantageous in operations where the problem is abnormal anatomy that needs correcting, such as with a hernia repair. Surgery to treat gastroesophageal reflux disease (GERD) involves modifying the anatomy of the upper digestive system and this is accomplished very effectively using minimally invasive surgery. The majority of surgery on the gastrointestinal tract can be done laparoscopically, even in many emergency situations such as appendicitis or the repair of a perforated ulcer.


What about laparoscopic weight-loss surgery?


Laparoscopic surgical techniques have revolutionized weight-loss (bariatric) surgery making it much safer and more accessible to patients who are suffering from severe obesity. Because most weight-loss surgery no longer involves big incisions, the risks of wound infections, incisional hernias, respiratory complications, and blood clots are significantly reduced.


Is laparoscopic surgery easier for surgeons?


Laparoscopic surgeries are more time intensive and often more complex than standard open surgeries. For these reasons, patients facing abdominal surgery would do well to seek out surgeons with in-depth laparoscopic surgery experience or specialized fellowship training in minimally invasive surgery. In the past fifteen years fellowship training in minimally invasive surgery has been offered for surgeons interested in gaining additional skills in advanced laparoscopic techniques. Some hospitals are performing robotic laparoscopic surgery, which makes it easier for surgeons who do not have advanced fellowship training to perform minimally invasive surgery. However, in terms of surgical results and potential future complications from scarring, robotic surgery does not provide better results than those of a surgeon who is fully trained in traditional laparoscopic surgery.


All of the general surgeons at Cayuga Medical Center have training and experience in laparoscopic surgery and two have advanced fellowship training in laparoscopic surgery. This gives us the credentials to do advanced, complex laparoscopic surgeries, which are typically not available in a community of this size.


Dr. Mecenas is board certified in general surgery and has advanced fellowship training in minimally invasive surgery, including weight-loss surgery. He is on the medical staff of Cayuga Medical Center and is in practice with Surgical Associates of Ithaca, where he can be reached at (607) 273-3161.



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