SurgeonMinimally invasive surgery has transformed medicine over the past three decades. Operations that used to require incisions of five inches or more, resulting in week-long hospitalizations, are now often accomplished with a few small incisions. Dozens of medical problems can now be treated with minimally invasive surgery, but a new study shows that too often they’re not.

Researchers at Johns Hopkins University School of Medicine examined statistics on minimally invasive surgery in hospitals around the country and found great variation in the practice–even when ample evidence exists to show that a particular minimally invasive approach is superior to open surgery.

In minimally invasive surgery, surgeons make a few small incisions (usually a half-inch to inch) and insert a camera, fiber-optic light and instruments through those incisions to remove diseased tissue or tumors or to stop bleeding. Previous research shows that, in carefully selected patients, minimally invasive surgery results in better outcomes, a lower risk of infection and complications, less pain, shorter hospital stays and faster recovery times.

However, the newest study, published recently in the journal BMJ, showed some hospitals are not providing minimally invasive surgeries when they should be. For example, an average of 71 percent of hospitals performed minimally invasive appendectomies, but the figures ranged wildly among hospitals–from 40.9 percent to 93.1 percent.

Common types of minimally invasive surgeries

If you’re scheduled for one of these procedures, ask if the operation can be performed using minimally invasive techniques.

  • Removal of uterine fibroids
  • Appendectomy
  • Hysterectomy
  • Cholecystectomy (gallbladder removal)
  • Prostatectomy (removal of prostate gland)
  • Coronary artery bypass surgery
  • Colectomy (removal of part of the colon)
  • Lung lobectomy (removal of part of the lung)
  • Nephrectomy (removal of a kidney)

While one hospital performed fewer than 7 percent of colectomies (surgery to remove part of the colon) with minimally invasive surgery, another hospital performed almost 50 percent of colectomies that way. The range for minimally invasive hysterectomies ranged from zero in one hospital (out of hundreds of cases) to more than 33 percent at another hospital.

The choice of surgical technique makes a difference. Complication rates for minimally invasive surgery compared to open surgery were 13.8 percent versus 35.8 percent for colectomy surgery and 17.1 percent versus 25.4 percent for lung lobectomy (removal of part of the lung).

The hospitals most likely to perform minimally invasive surgery were large, teaching hospitals located in the Midwest, South or West. To find a teaching hospital, look for a hospital associated with a university, such as a state university system.

Surgeons often perform the style of surgery they learned in residency, even if better techniques have since been developed, the study’s authors noted. However, hospitals should make choices available to patients and be transparent about the types of surgeries they offer–or don’t offer.

Consumers, Too, Need to Ask Questions

“Physicians have an obligation to inform patients about all their options, even if we don’t offer all the options ourselves,” says Marty Makary, MD, a professor of surgery at Johns Hopkins University School of Medicine and the lead author of the study. “Patients who need an open procedure could be sent to surgeons skilled in open surgery. Those who are candidates for minimally invasive surgery could be directed to a surgeon with minimally invasive skills, sparing more patients the risks associated with open surgery.”

Sources:
BMJ – http://www.bmj.com/content/349/bmj.g4198

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