Letters.

The Laparoscopic Advantage

Dr. Mickey Karram was correct that there are few clinical trials comparing laparoscopic procedures with conventional treatment and that there is a significant learning curve ("Is It Really a Surgical Advance?" Guest Editorial, Oct. 15, 2001, p. 7).

There are, however, a few well-known facts. Laparoscopic surgery is more expensive and often is more time consuming. It is more technically difficult but patients recover faster and the surgeon benefits from improved visualization.

It is important in controlled studies to compare procedures performed by advanced conventional surgeons with procedures performed by advanced laparoscopic surgeons and to compare a procedure performed in an open fashion with a procedure accomplishing the same goal but in a different manner by a laparoscopic method.

As a laparoscopic surgeon myself, when faced with a radical prostatectomy I chose to have it done laparoscopically and traveled to Paris to find someone of sufficient experience. The crucial aspect of radical prostatectomy was precision and I believe that, with laparoscopic tools, an accomplished surgeon can perform the surgery more precisely than with the conventional method.

I am very pleased with my decision and had the added benefit of being back in practice and operating again in less than 2 weeks from the day of my surgery.

So there are two very definite answers to the question "Is it really a surgical advance?": yes and no. The surgeons who are good at laparoscopic surgery would say yes, and others would say no.