What should surgeons consider when choosing products for single port surgery?
July 1, 2011
When choosing single port surgery products, surgeons should consider: Product efficacy, ease of use and cost effectiveness.
Many can still remember the early laparoscopic cholecystectomy procedures of the late '80s which took an inordinate amount of time to perform compared to today’s procedure time values along. Surgeons also had to address the relevant issues back then surrounding the laparoscopic approach to gall bladder removal such as, appropriate training and patient selection, indications and contraindications, absence of meaningful data, lack of reimbursement, proctoring, credentialing, privileging, differences in surgical approaches along with surgical equipment selection, less patient hospital stay and earlier return back to work. What drove acceptance and adoption of this general surgery procedure that would go on to drive MIS as a standard of care was the metrics of patient outcomes and associated cost benefits. At that time, the gap between open laparotomy and the laparoscopic approach was significant. Of course, the rest is history.
At this juncture in time, a major gap between conventional laparoscopic and single port approach has not been firmly established. Moreover, there may not be a major gap. Clearly, on a cosmetic front, there seems to be inherent benefit, but that alone may not be adequate to drive broad adoption.Though early available data regarding metrics of patient outcome is encouraging, many questions still need to be answered before scalability of the single port approach can be determined.
When it comes to available technology, the FDA does a good job of addressing safety and efficacy. However, the FDA is not and will never be responsible for training and other aspects of medical device technology that can determine acceptance and adoptability. It continues to be the responsibility of the practitioner to ensure self-competence with the tools that they use and to have the wherewithal to select the tool that best fits their technique.
Today, surgeons performing single incision surgery are faced with multiple equipment options, but the major limitation associated with many of these devices is that the surgeon must alter his/her technique away from a conventional MIS platform that not only works, but is also supported by an impressive body of scientific literature that spans several decades.
Aside from patient outcome, surgeons should also consider the economic impact. Now more than ever, the reflection as to, ‘is it better for the patient?’ needs to be counter balanced by cost consideration.
The single port approach is still in evolution. I believe that it is here to stay, but the rate and extent of adoption will be determined by product evolution, ease of use, and impact to patient and fiscal outcomes.