Enhancing recovery with minimally invasive surgery: Increasingly the best option for patients

As a surgical patient, which would you prefer?

One-week hospital stays, debilitating pain, month-long recoveries and long, ugly scars? Or a couple of days in hospital, over-the counter pain medication, full recovery in a matter of weeks and tiny incisions leaving almost undetectable scars?

Obviously, the second scenario is preferable. Such optimal outcomes are the result of minimally invasive surgery (MIS), which has played an instrumental role in the transformative improvement in surgical procedures – as well as efforts to standardize pre- and post-operative care.

For more than three decades, the treatment and recovery of millions of Americans has been enhanced by skilled, well-trained physicians who have mastered the art and science of laparoscopy and endoscopy that require smaller more precise incisions. From gall-bladders to hernias, or colon and rectal surgeries, thousands of patients suffer less, and recover more quickly because they avoid the complications that more often occur from open surgeries that require larger incisions in the muscles of the abdominal wall.

The pity is that even more patients could benefit from MIS if more of the nation's hospitals, physicians and clinics placed a stronger emphasis on readying their staff and facilities to become more adept in these surgical advancements. However, this will likely need to be fueled by having informed patients demand such practices.

MIS triggers a virtuous cycle
The beauty of MIS is that the identical operation to open surgery is performed through one or a few small incisions, with the use of microscopic cameras that give the surgeon a high-resolution, crystal-clear view of the area being treated. Faster and more efficient, most MIS procedures are typically much less costly than open surgeries, a boon to patients and insurers.

The challenge with MIS, though, is that the procedures require years of training in complex techniques and advanced technological instruments that can make mastery quite difficult. As a result, some medical institutions have not been able to invest the time and talent required to grow their MIS expertise. Instead, they continue to rely on open surgical techniques for types of surgeries that could otherwise be conducted via MIS.

Patients have a role in growing MIS
Patients should now presume that many types of surgeries can be optimized via MIS, and they should actively seek answers to questions they may have about possible surgical options.
Physicians should encourage patients to take the time and make the effort to ask prospective surgeons the tough questions that can help shape their surgical choice. Picking a surgeon is not like buying a car, where many dealerships carry the same models. The experience and level of care you receive can vary significantly between healthcare providers and practitioners.

Therefore, don't hesitate to ask a prospective surgeon any or all of the following questions:
• Where did you train in this type of surgery and how often have you performed it?
• What are the complications associated with the procedure and how often do they occur?
• Will you be able to handle any potential complications, or will I be referred to another physician or hospital?
• Can the type of surgery I need be performed – effectively – via MIS? If you don't do this laparoscopically, would other surgeons do it using MIS?

In addition to these direct questions and answers, patients should also consider conducting third-party research online to learn more about their surgeon and the institution where the procedure is being performed. Patients should look into whether or not the surgeon in question has conducted surgical research or has been published in medical journals, if the individual has written extensively on a topic, and taught or delivered talks on the procedure.
A strong background and recognized excellence in surgery and the procedure are good indicators that the physician has more experience and recognition in this area.
Unsatisfactory answers, low ranking and/or the unwillingness of the practitioner to provide direct, non-evasive answers are signs that your search for the right surgeon should continue.
The point is ... you want (and deserve) every opportunity to make sure your surgery is done, correctly, efficiently and successfully – the first time.

Conor Delaney, MD, PhD, is the Chairman of the Digestive Disease and Surgery Institute at the Cleveland Clinic.


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