El Camino Hospital doctors recently learned how to perform laparoscopies with just a single stitch through the navel – the latest in a new wave of minimally invasive procedures.
They didn’t have to go far for the training, either, because a mobile operating room came to them, parked behind the hospital by Covidien, maker of the single-incision laparoscopic surgery (SILS) devices used in such procedures. Thanks to the 85-foot semitruck with a state-of-the-art operating room parked on Hospital Drive, approximately 20 surgeons sharpened their skills without leaving their practices last month.
Like other minimally invasive procedures, this one results in less pain and trauma, faster recovery time and minimal scarring, according to studies. Patients also tend to have fewer wound complications. The benefits to doctors include more business, greater surgical precision and fewer hours in the operating room.
The doctors appreciated the convenience of the training.
“We usually have to go across the country,” said Los Altos’ Dr. Anna Wong, an ob-gyn from Camino Medical Group who tested the robotic instrument.
Training doctors to perform procedures at their home base allows them to provide gall bladder and kidney removals, hysterectomies and gastric bypasses sooner.
Several employees of the Connecticut-based Covidien, manufacturer of the SILS device, observed as physicians inserted the instrument into model navel “ports,” or openings. In addition to the hands-on experience, doctors listened to a lecture and PowerPoint presentation in the 1,200-square-foot mobile training room.
Interacting with patients:
What to say?
Dr. Homero Rivas, general surgeon and assistant professor at Stanford University Medical School, showed slides of an appendectomy, a gall-bladder removal and other laparoscopic surgeries using the long-handled instrument. The SILS device allows doctors to perform laparoscopic surgeries through the abdomen or in tight spaces like the pelvic cavity because the tip rotates 360 degrees. The 75-degree articulation results in more precision because of the rotating capacity.
While instructing physicians how to insert the instrument “like a shoehorn,” Rivas told the assembled doctors, “This is nothing new for you, because you all perform laparoscopies.”
He stressed the importance of choosing patients for the procedure carefully and recommended avoiding those with umbilical hernia repair, the very thin, the morbidly obese and those who had previously undergone abdominal surgery.
In addition to greater safety, he said, single-incision procedures leave patients without a visual reminder of the laparoscopy.
Los Altos resident and Palo Alto Medical Foundation ob-gyn Dr. Karen White said she was “intrigued” by the technique and attended the training because she wanted to try it. After all, she said, “I would want a single incision, if I had a choice.”
Patricia Rogers, M.D., an El Camino Hospital ob-gyn and Los Altos Hills resident, agreed the procedure was a good way to go for some patients who want to hide scarring.
“I think it’s cool,” she said.
However, it takes more than one training session to be able to perform the technique properly. The learning curve requires approximately 20 cases before doctors are fully qualified to use single-incision laparoscopy.
Rivas said the one-day instruction would “by no means make someone qualified to do this type of surgery” but would raise awareness of new techniques and technological innovations. To gain expertise, he said, one needs “formal training through mentoring – ideally in the operating room, and experience in animal or dry labs like this one.”
Covidien representative Eileen Gilhooly noted that one surgeon who attended the training had already received a request from a patient for the procedure.
For more information, visit www.elcaminoinnovates.org.