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Member 4546 · 07-31-2003, 03:01 PM

I have thankfully graduated beyond laparoscopy @ this point. I used to be impressed more by it then I was by the time I finished general surgery. For many complex procedures it seemed that all I was doing was torturing myself with longer operations when the patients really didn't seem to do that much better. Laparoscopy is a pretty big advance for gallbladders, spleens, ventral hernias, reflux surgery, gastric banding, and diagnosistic exams for abdominal pain NOS. I never saw much advantage for inguinal hernias, appendectomy (where you're sure of the diagnosis), colon surgery, nephrectomy, liver resection & RFA procedures, or pancreatic cases.

I've also come to the opinion that laparoscopic bariatric procedures (banding excluded) are inherantly unsafe because you make too many compromises in technique to get it done thru the scope that you would never accept if you did it open - I think there are a lot of surgeons who would not reccomend this to a family member @ this point in time even though its being done more widely for marketing reasons mostly. Most of you who have seen good results so far will have you enthusiasm tempered when you start seeing the leaks, marginal ulcers, & other frequent complications that go with the procedure. It took me scrubbing with a few surgeons who have done over 1000 of them (open GBP) to realize that you can do it very quickly with little morbidity thru miniscule incisions & a 2-3 day stay for most patients. For your training also, open GBP is very underated. Most residents dread them, but you get to do a number of manuevers that you incorporate into other advanced cases & trauma procedures (esophageal mobilization, gastric division/anastamosis, roux-en-y limb construction, SB anastamosis, retrocolic & retrogastric manuevers) that can really teach you a lot of anatomy. I think I ended up doing close to 50 of the open ones during my training & it was a very important part of my familiarity with the abdomen. If you get the chance to do these (and organ transplant harvests) as junior residents jump all over it!

07-31-2003, 03:01 PM	#6
Member 4546 1K Member Status: Attending Join Date: May 2001 Location: Birmingham, AL Posts: 1,487	I have thankfully graduated beyond laparoscopy @ this point. I used to be impressed more by it then I was by the time I finished general surgery. For many complex procedures it seemed that all I was doing was torturing myself with longer operations when the patients really didn't seem to do that much better. Laparoscopy is a pretty big advance for gallbladders, spleens, ventral hernias, reflux surgery, gastric banding, and diagnosistic exams for abdominal pain NOS. I never saw much advantage for inguinal hernias, appendectomy (where you're sure of the diagnosis), colon surgery, nephrectomy, liver resection & RFA procedures, or pancreatic cases. I've also come to the opinion that laparoscopic bariatric procedures (banding excluded) are inherantly unsafe because you make too many compromises in technique to get it done thru the scope that you would never accept if you did it open - I think there are a lot of surgeons who would not reccomend this to a family member @ this point in time even though its being done more widely for marketing reasons mostly. Most of you who have seen good results so far will have you enthusiasm tempered when you start seeing the leaks, marginal ulcers, & other frequent complications that go with the procedure. It took me scrubbing with a few surgeons who have done over 1000 of them (open GBP) to realize that you can do it very quickly with little morbidity thru miniscule incisions & a 2-3 day stay for most patients. For your training also, open GBP is very underated. Most residents dread them, but you get to do a number of manuevers that you incorporate into other advanced cases & trauma procedures (esophageal mobilization, gastric division/anastamosis, roux-en-y limb construction, SB anastamosis, retrocolic & retrogastric manuevers) that can really teach you a lot of anatomy. I think I ended up doing close to 50 of the open ones during my training & it was a very important part of my familiarity with the abdomen. If you get the chance to do these (and organ transplant harvests) as junior residents jump all over it!