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From: "Howard McCollister" <>
Subject: Re: Total colectomy/larproscopy
Date: 19 Aug 2004 07:22:19 -0500
Message-ID: <41249ac4$0$11072$>

"Griffin" <> wrote in message
> On 2004-08-17 08:09:12 -0400, "Howard McCollister" <>
> > This is technically difficult laparoscopically
> > and very prone to complications, the end result possibly being an ileostomy
> > at a second operation.
> Ditto. Just because something *can* be done through the 'scope doesn't
> always mean it *should* be done through the 'scope.  ;-)

Well, that's generally true, but it's a complex subject. Generally,
complication rates are higher for laparoscopic versions of what have
typically been open operations. This is in part because these operations are
harder to do laparoscopically, but also because the era of laparoendoscopic
surgery is only about 10 or 12 years old and we are still on the steep part
of the learning curve. There are many surgeons doing advanced laparoscopic
surgery that simply shouldn't be - their brains just aren't wired for
2D-->3D conversion. Additionally, the training in laparoendoscopic surgery
in surgery residencies is absymal. Minimally invasive fellowships are few
and far between - currently only about 80 accredited in the entire US.

So, the result is that undergoing a laparoscopic colon resection, or any
major laparoscopic operation, requires that the patient be very, very
careful about understanding the credentials and skills of the surgeon he or
she selects.


From: "Howard McCollister" <>
Subject: Re: Total colectomy/larproscopy
Date: 19 Aug 2004 12:39:33 -0500
Message-ID: <4124e535$0$83629$>

"Mark & Steven Bornfeld DDS" <> wrote in message

> >
> Thanks for this.  It's totally logical, but from what I've seen and
> heard the advantages of laparoscopic surgery (or any type of fiber-optic
> scope procedure) are spoken of much more than the disadvantages.

Overall, statistically, the advantages of laparoscopic surgery significantly
outweigh the disadvantages, but there can be significant variability from
surgeon to surgeon. As more and more laparoendscopic surgeons are trained,
and as the Nintendo-generation becomes surgeons, the slightly higher
complication rates will get lower and high quality MIS will become more
widely available. The problem is the time frame. Currently, there are only
80 MIS training fellowships and almost all of them finish only one fellow
per year. It's going to take awhile.

Because laparoendoscopic surgery is hard, the majority of surgeons are
unwilling or unable to do it for more advanced operations. A good example is
Lisa (here on She had an open stomach resection for intractable
ulcers. That operation can be done laparoscopically by someone that knows
how. More importantly, she could have had a laparoscopic highly selective
vagotomy as an outpatient, left the hospital the same day. Instead, she got
the exact same operation that they might have done 50 years ago. I don't
think a laparoscopic approach was even offered to her.

I agree with Griffin's post that just because and operation CAN be done
laparoscopically doesn't mean it SHOULD be done that way. However, I would
point out that in the majority of situations, an open operation is
recommended more for the surgeon's lack of laparoscopic ability than whether
or not is should be. In other words, just because an operation SHOULD be
done laparoscopically doesn't mean it CAN be done that way by that
particular surgeon.


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