GUIDELINES
Many associations and societies have recommended that by reducing the impact of surgery we can increase the possibilities of better patient outcomes.
The European Association of Endoscopic Surgeons (EAES) guidelines state that when operating laparoscopically, the lowest possible pressure level should be applied and the lowest diameter instruments and evacuate the gas at the end of the procedure.
In addition, there was a requirement to remove residual gas. These are the definitions described by EAES:
- Apply lowest possible pressure level (Grade A)
- Use small instruments, if suitable (Grade A)
- At the end of the operation, remove residual gas (Grade B)
STREAMLINING THE PATIENT PATHWAY
The NHS has been under pressure to shorten waiting lists for years, but the onset of the Covid-19 pandemic and the disruption to elective treatment has meant that waiting lists have reached their highest ever levels.
More than ever, patient pathways need to be streamlined, to treat patients more efficiently and reduce hospital stays.
Amongst other factors, low impact surgery may result in less pain for patients allowing them to recover faster. This can result to reduced PACU time and quicker discharge, without compromising patient safety.
HOW CAN LOW IMPACT LAPAROSCOPY BE ACHIEVED?
There are other ways, beyond low pressure that make a surgery low impact. Low pressure is of course a strong factor, but other factors include the creation of smaller incisions.
Low impact laparoscopy can see incisions reduced to 3 mm from 5-10 mm by using 3 mm instruments and ports, this is sometimes known as microlaparoscopy. There are many different reasons why this might be beneficial to patients and hospitals.
Shorter hospital stays: Patients treated through microlaparoscopy may be able to leave hospital sooner. A 2009 study found that hospital stays were brought down from an average of 3 days to 2 days for patients with smaller incisions¹.
Reduces pain: In a double-blind controlled study, 60 patients were randomized to undergo either microlaparoscopic cholecystectomy using one 10-mm and three 3.5-mm trocars or traditional laparoscopic cholecystectomy using two 10-mm and two 5-mm trocars. In the 3.5-mm LC group, incisional pain was significantly decreased in the 1st postoperative week as compared with the LC group (p <0.01)2.
Improves cosmesis: Smaller incisions improve the cosmetic preservation of the patient.
Staff do not need to be retained: Typically, advantages in surgery come with a learning curve; however, low impact laparoscopy operates in the same way as normal laparoscopy. Therefore, there is no need to spend valuable time retraining staff. In addition, with the advent of newer, stronger, 3 mm instruments, such as EvoLap, there is an ability to manipulate heavier organs and tissues.
USING LOW IMPACT AS PROTOCOL
All of the techniques that have been discussed can lower the impact of surgery, however, for optimal results they should be used in conjunction for a low-impact laparoscopy surgical protocol.
There are many successful examples of using a low impact approach; for more details see the bibliography below.
We believe low-impact laparoscopy is the next step in laparoscopic surgery in order to reduce patient pain, and recovery time and speed up patient discharge with the result of greater patient throughput in surgery.
“Discover our surgical solutions designed to support low impact surgery and enhance recovery outcomes.”
References
1. Ghezzi F, Cromi A, Siesto G, Zefiro F, Franchi M, Bolis P. Microlaparoscopy: a further development of minimally invasive surgery for endometrial cancer staging — initial experience. Gynecol Oncol. 2009 May;113(2):170-5. doi: 10.1016/j.ygyno.2009.01.015. Epub 2009 Feb 24. PMID: 19243814.
2. https://link.springer.com/article/10.1007/s00464-001-9026-5
3. Yeung PP Jr, Bolden CR, Westreich D, Sobolewski C. Patient preferences of cosmesis for abdominal incisions in gynecologic surgery. J Minim Invasive Gynecol. 2013 Jan-Feb;20(1):79-84. doi: 10.1016/j.jmig.2012.09.008. PMID: 23312246.
