Minimally Invasive Surgery

In the past decade, minimally invasive surgery--which involves using small instruments to operate instead of cutting a patient open--has taken off, replacing open surgery for procedures like gallbladder removal and hernia repair.

It is even being used for coronary bypasses. There is a noticeable difference in scarring between open heart surgery and a similar minimally invasive procedure.

Patients also benefit from this revolutionary approach: It means less pain, fewer complications, and quicker recovery times.

But despite its popularity, organized training for doctors has been sorely lacking, and that can put patients at risk.

"What we found was there were people at that time who were trying to do the operation minimally invasively and did injure patients," says Dr. Alan White, director of Montefiore's Institute for Minimally Invasive Surgery.

At Montefiore Medical Center's brand new virtual-reality lab, 5-year surgical residents will begin training on virtual-reality equipment in their first year.

One surgical resident uses his hands and feet on medical training equipment to learn the mechanics of minimally invasive surgery by watching a video program that guides him through the exercises.

"Initially, it's disorienting," Dr. James Lee says, "because it's hard to get used to where in space the tools are."

In one exercise, Lee tries to grasp a ball and place it in a box. The movement simulates skills used in actual surgery and is the same technology used to train fighter pilots.

According to surgical specialists, the demand for quicker hernia repair and gallbladder removal has outpaced the supply of qualified surgeons.

"We now use this technology to remove parts of the colon and transplant kidneys," White says. "Obviously, you can't do that unless you have these very significant skills."

Learning the new techniques is challenging, to say to least. Unlike open surgery, which is three-dimensional, most minimally invasive techniques are two-dimensional. That means you lose the sense of depth and touch.

"The hardest thing for me is depth perception," says Dr. Tara Sotsky, a surgical resident. "So I'm always paying attention to the depth of my instrument and it tells me I'm too far which is usually my problem."

Another curve ball is that movements are counterintuitive. "When you want the instrument to go left, the shaft of your hand has to go right," White explains.

He says not all residents can excel in this format; but many can, and that's important to future patients.

"Think about it," he says. "If your surgeon doesn't learn this technology and doesn't have it in their armamentarium, will they offer you this kind of surgery? No."

If your doctor tells you a certain surgery cannot be done in a minimally invasive fashion, seek a second or third opinion.

To find a doctor qualified in minimally invasive techniques contact the society of laparoendoscopic surgeons: www.sls.org

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