conventional laparoscopic surgery is modest.
Should you be encouraging your surgeons to take the big step to
incisions so small, you don't need to close them, except at the skin
level (or recruiting surgeons who've already downsized their inci-
sions), while promoting the twin benefits of less pain and virtually
imperceivable scarring to a public that's bound to be intrigued? Here
are some factors to consider.
Easy learning
Unlike single-incision surgery or the NOTES (natural orifice translu-
menal endoscopic surgery) approach, the setup for micro-lap surgery
is the same as it is for standard laparoscopy, so you don't have to
modify your technique tremendously and the technique on the whole
is much easier to teach. The small learning curve arises from the fact
that you have to be more precise about where you put your trocars
and more careful about their trajectory. This is important because
poorly placed microlaparoscopic instruments can't withstand a lot of
force in the abdominal wall that might be needed to counteract bad
placement. They may even bend if you persist in fighting. The good
news is they can be repositioned with minimal trauma.
Incidentally, some use the terms micro- or mini-laparoscopic surgery
interchangeably with the term needlescopic surgery, but there's a dif-
ference, and I believe micro-lap with a trocar is safer than needlescop-
ic surgery because micro-lap instruments aren't sharp. Needlescopic
surgery relies on the sharpness of the instrument to obviate the need
for a trocar.
Numerous opportunities
Cholecystectomies and appendectomies are the procedures most com-
monly associated with the micro approach, but I've used it in a variety
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