made of steel for increased rigidity and come at longer lengths for
bariatric cases. Recently I had a fellow who assisted on a Roux-en-Y
gastric bypass, though she never had done one before. She only used
3 mm instruments and everything went well. The 2 mm options are
trickier, since they are less sturdy and harder to maneuver in the
abdomen.
What about visualization during mini-lap?
Dr. Novitsky: The choice in mini scopes is a challenge, since the 2 mm
and 3 mm optics may not be sufficient. That's fairly easy to overcome.
Most common mini-lap cases use a 10 mm port to remove a specimen
anyway, so you can just use a conventional scope.
Dr. Reardon: Mini cameras are adequate for most surgeries. You see a
smaller, but just as high-quality, image with our 3 mm scope compared
to our 5 mm one. Our 2 mm camera has a lot less resolving power,
though it's still suitable for most cases. We've done 1,200 2-mm lap
choles since 1996, and have had only 1 common bile duct injury — and
that was due to poor cautery use, not poor visualization. The main
problem is that the 2 to 3 mm cameras aren't yet long enough for
bariatric cases.
Final words of advice about adding mini-lap?
Dr. Curcillo: It's a significant investment — each instrument can cost
several hundred dollars, and each case may require several — but
consider whether you're going to lose business not offering mini-
laparoscopy. Patients aren't necessarily coming in demanding mini-
lap, but they do ask for smaller incisions. And if the hospital down the
street has the technology, their surgeons may go there instead.
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