High-tech surgery options have risks, too

Consumers today have more options on how their surgeries are performed – with minimally invasive methods, with robots to assist the surgeon in these types of operations or with traditional open surgery. But each has risks and benefits.

“For almost everything you can think of, there are several new ways to do things,” says Dr. Paul A. Wetter, chairman of the Society of Laparoendoscopic Surgeons. “It’s up to people to become as educated as they can about these things. You should talk to board-certified doctors and get several opinions.”

Many minimally invasive procedures reduce pain, blood loss and the risk of infection and reduce hospital stays and recovery time.

However, the latest or most high-tech surgery isn’t always the best choice, experts caution. Just as in open surgery, there are downsides to minimally invasive surgeries that consumers should explore. Before committing to an approach, ask your doctors about these factors:

Physical experience – The success of many minimally invasive surgeries depends on the surgeon’s training and experience. Consumers should ask the surgeon about experience with the procedure being considered. Some doctors say it takes about 20 procedures before they feel comfortable performing something new.

“Go to a good, board-certified doctor and then go with the procedure they are doing because they have the most experience in that procedure,” Wetter says. “Don’t try to talk them into doing something that is new that they don’t have a lot of experience doing. The results with older procedures may be better than the results of newer procedures.”

Data – Minimally invasive surgery is so popular for many conditions that studies showing the safety and effectiveness of a particular operation and how it compares with a traditional approach often lag behind actual practice. It’s common for doctors to debate whether a minimally invasive option offers any advantages over the traditional approach.

Find out if there are studies showing whether a minimally invasive approach is as good or better than the traditional surgery. If the research hasn’t been done, seek opinions about the pros and cons of each approach.

“The technology is advancing faster than our ability to evaluate it,” Wetter says. “But there is a point where something is so significantly better and obviously better that you have to use good judgment and then wait for the long-term studies.”

Burns and other risks – A major risk unique to minimally invasive surgery is burns that can occur when surgeons mistakenly touch tissues with electricity-emitting instruments that cut and seal tissue. Some of these instruments, if not properly maintained, can give off stray sparks that burn tissues.

“It happens in a small percentage of cases, but it can be a devastating problem,” says Dr. Joel Bauer of the department of surgery at Mount Sinai Hospital in New York.

Patients should ask if the hospital or surgery center uses instruments designed to prevent stray electrical burns. They also should question a doctor about how well a hospital or outpatient surgery center maintains its robotic and laparoscopic equipment and its rate of complications involving burns, Bauer says.

People undergoing minimally invasive surgery also should ask about unforeseen complications that would require the surgeon to switch to an open surgery. An unexpectedly large tumor or excessive bleeding sometimes can force the surgical team to abandon the minimally invasive approach after the operation has begun. Surgeons should tell you the percentage of cases in which they have to convert to open surgery.

Cost – One area in which minimally invasive surgery is often not superior to open surgery is cost. These operations usually take longer, and technology, such as robots, can add even more to the price tag.

Insurance companies typically reimburse a hospital and surgeon the same rate no matter which surgical technique is used. Consumers should ask about cost comparisons and if they will be charged more for a minimally invasive procedure.

Recovery – When it comes to recovery, the advantages seen in simple minimally invasive surgery are not always as spectacular in complex surgeries.

In a study in the New England Journal of Medicine, patients who underwent minimally invasive colon-cancer surgery stayed in the hospital five days and needed narcotics for three days; those who had traditional surgery stayed six days and needed narcotics for four.