Minimally invasive techniques like laparoscopy and surgical robotics have dramatically decreased the size of surgical incisions and scars. But there’s a new type of surgery that goes one step further. Ultra-minimally invasive surgery, also known as needlescopy, uses surgical instruments so small, scars are virtually unnoticeable and pain is minimal.
Traditional laparoscopy uses small incisions to access internal anatomy. Compared with traditional or open surgery, there is less scarring, less pain and faster recovery. Needlescopic surgery shares these benefits, but because it uses “needle-size” incisions, it is even less invasive.
“Ordinary laparoscopic instruments vary in girth from 5 to 15 millimeters and will leave various size skin scars accordingly,” says Houman Solomon, MD, a physician with the Association of South Bay Surgeons who specializes in minimally invasive surgery. In contrast, needlescopic surgery utilizes instruments that are around 2 millimeters in diameter—about the size of a large-tip pen.
Because the tools are so tiny, surgeons can access the abdominal cavity without having to make large incisions. The decreased size translates to less trauma to the abdominal wall and therefore less pain.
Cosmetically, the scar is so small that it is usually not visible after the skin heals, says Dr. Solomon.
Ultra-minimally invasive surgery is appropriate for a variety of indications, but according to Dr. Solomon, it is best suited for general abdominal surgical procedures like hernia, gall bladder, appendix, weight loss surgeries and intestinal operations. It is also used in many gynecological procedures. The technique and the instruments may not be as useful in patients who carry a lot of weight in their abdominal area.
“In a great majority of cases, there are no drawbacks, as the instruments and the technique are very safe. At times, slightly longer anesthesia times may be required,” notes Dr. Solomon.
As with all minimally invasive surgeries, a physician must go through advanced training to become adept at performing these procedures. Dr. Solomon, who completed his training for minimally invasive and robotic surgery at Stanford University, has been performing ultra-minimally invasive surgeries for about two years. However, the technique is still relatively new, so not all hospitals offer ultra-minimally invasive surgery.
Torrance Memorial Medical Center is one hospital that does offer the technique. “For now, only a select group of surgeons that are truly facile with minimally invasive techniques are performing these procedures at a small number of hospitals. It is an evolving field, and I expect many more centers will offer this service in the future,” say Dr. Solomon.