Future trends in minimally invasive surgery

AORN Journal,  Dec, 2005  by Krista Bragg,  Nancy VanBalen,  Nathaniel Cook

• E-mail
• Print
• Link

The article "Future trends in minimally invasive surgery" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Dec 31, 2008. Complete the examination answer sheet and learner evaluation found on pages 1021-1022 and mail with appropriate lee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on minimally invasive surgery (MIS), nurses will be able to

1. explain the scope of MIS within the context of its historical development,

2. discuss current trends in MIS,

3. identify issues that affect the MIS learning curve, and

4. describe recommendations that will help facility managers plan for the technological changes brought about by MIS.

The cost of healthcare in the United States is climbing annually at a staggering rate, currently totaling more than $2.2 trillion? The United States is projected to spend approximately 16.3% of its gross domestic product (GDP) on health care by the year 2008.1 This amounts to $7,768 per person, almost double the $4,177 per capita amount spent in 1998. (1) With an average annual growth rate of 7.3% from 2001 to 2011, health care expenditures could reach $2.8 trillion in 2011. (2) Expanding 2.5% faster than the GDP, the cost of healthcare will consume close to 17% of the GDP by 2011, the highest percentage in history. (3) Such expenditure growth concerns people in both the public and private sectors and has prompted aggressive and widespread efforts to manage healthcare expenses.

Technology often is blamed for rising healthcare costs; however, some medical advances, such as endoscopic surgery, are critical to improving health care efficiency, enhancing the quality of care provided, and decreasing overall expenses. Patients in today's healthcare facilities are experiencing the benefits of advanced technology as evidenced by higher quality-of-life scores after minimally invasive surgery (MIS) compared to traditional open surgery. (4-6) Hospital stays are shorter, and often the need for overnight stay is eliminated. (5) Postoperative pain is less and patients are able to return to work sooner. (4-6) This is not only an advantage to patients, but to the healthcare economy as well.

Savings or profits directly related to technology initially may be difficult to measure quantitatively. When surgeons reach the peak of the learning curve for performing MIS procedures, complication rates drop significantly. (7-9) The many obvious benefits to MIS affect today's healthcare facilities by encouraging consumer desire for MIS options.

DEFINING PARAMETERS

The term laparoscopy, named for the keyhole-size incision, also is referred to as minimally invasive surgery (MIS), although by definition laparoscopy refers to endoscopic examination of the abdominal cavity? (10)(p974) Minimally invasive surgery actually incorporates all fields of endoscopic surgery (eg, orthopedic, genitourinary, gynecological, ears, nose, throat) using small incisions or no incisions, such as with an endoscope (Figure 1) rather than traditional open methods. (10)(p1106) Advantages of MIS include

[FIGURE 1 OMITTED]

* decreased size of incision sites,

* decreased postoperative pain,

* decreased recovery period, and

* quicker return to work and family. (11-14)

Endoscopic MIS improves overall patient productivity (eg, permitting patients to return to their jobs sooner) while simultaneously decreasing hospitalization costs, often allowing patients to avoid hospitalization altogether. (11-14)

HISTORY

The first recorded MIS procedure was performed around 400 BC by Hippocrates using a primitive speculum and rectoscope to evaluate hemorrhoids. (15) Early advances in MIS occurred long before modern concerns about decreasing surgical costs and the length of time patients remain in hospitals. Technology was limited, and surgeons practiced techniques on animals while developing new equipment, particularly light sources for use in dark body cavities. (16) Since Hippocrates, numerous surgeons have experimented with MIS, including Antoine Jean Desormeaux, MD, a French surgeon in 1853, who has been referred to as the "father of endoscopy." (17) With each generation of surgeons, surgical technique has been further advanced and refined.

By the late 1970s, gynecologic surgeons embraced laparoscopy and thoroughly incorporated these techniques into their practice. (18) The first laparoscopic-assisted appendectomy was performed 1977. (19) The first recorded laparoscopic liver biopsy was performed in 1982. (20) Surgeons in France reported performing the first surgical laparoscopic cholecystectomy in 1987. (21) The United States (22,23) and the United Kingdom (24) began performing these procedures laparoscopically in 1988.