New Techniques in Diagnostic Laparoscopy

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Dr. Larry Demco: "I’m Dr. Demco, reporting from the 4^th Annual Global Symposium on New Microscopic Techniques in Miami, Florida. I’d like to interview Dr. Patrick Osam from Little Rock, Arkansas, who is one of the attendees at the conference. Dr. Osam is a physician who has a long history of studying under some of the top people in general surgery, including Dr. Peter Geis, who is one of his mentors. He’s recently been looking into new techniques of diagnostic laparoscopy as another method to add to his repertoire for the new diagnosis of abdominal pain. Doctor, could you please tell us a little bit about your frustrations with abdominal pain in the past?"

Dr. Patrick Osam: "Sure. In most incidences, patients have been referred to me by primary care physicians or gynecologists, especially patients who’ve had prior multiple abdominal surgeries, including hysterectomies, and have continued pelvic and abdominal pain. They have had extensive evaluations – GI evaluations with endoscopies, upper and lower endoscopies, contrast studies of the small intestine, barium enemas, CT scans, and sometimes MRI 's – and have exhausted all their diagnostic evaluations for the causes of their abdominal pain. They are sent to me as a last resort to try and decide what the cause of their abdominal pain is and to see if there is a surgical remedy."

Dr. Larry Demco: "What, then, do you foresee for the role of laparoscopy in the diagnosis of the abdominal pain that seems to be a frustration for you?"

Dr. Patrick Osam: "What I’ve learned at today’s conference is how to directly examine areas of the abdomen in the conscious patient under local anesthesia. I've also learned to specifically identify those definitive areas that seem to be the cause of abdominal pain, especially those of adhesions and other pathologies such as endometriosis that may have been missed by other diagnostic evaluation up to that point."

Dr. Larry Demco: "What have you been taught about adhesions, and what has this conference done to your impressions of adhesions now?"

Dr. Patrick Osam: "Traditional teaching was that most often after any intervention in the abdominal cavity, there really was not a lot that could be done, which basically left the patients at the end of the road when it came to their problems. But with the information at this conference, I’ve learned that there are different types of adhesions, and that the types that we traditionally thought were the cause of the abdominal pain are not necessarily the ones that cause the pain after all. They certainly can cause obstructions, but the ones that cause the pain are of a different type and are very remediable with laparoscopic techniques."

Dr. Larry Demco: "Where do you also see the role of the traditional 10-mm and 5-mm instruments with performing normal operative general surgery procedures? Where do you see the role of the smaller 2-mm and 3-mm instruments?"

Dr. Patrick Osam: "In my earlier training, when the technology was first developed for general surgeons, all we had available for standard operations of a laparoscopic cholecystectomy, appendectomy, colon resections, Nissen fundal plications procedures, and splenectomy were 10-mm and 5-mm ports. But as the excellent faculty members at this conference have pointed out, we’ve now learned that we can use 3-mm and 5-mm ports, and possibly all with 3-mm ports, for the same operations we’ve traditionally done with 10-mm ports. This will allow patients to have less pain, earlier discharge, a quicker return to normal activities, and still accomplish the same therapeutic goals as the operations done with 10-mm ports."

Dr. Larry Demco: "We all recognize the difference between an open laparotomy and general laparoscopy, regarding the patients' stay. Do you see any advantages for the patients in moving from the 5-mm instrument to the 3-mm instrument in the post-operative state?"

Dr. Patrick Osam: "Absolutely. The decrease in the size of the ports would decrease the post-operative pain and the extended recovery period for the patients. We could possibly do operations that would require an overnight stay – or, from a one- or two-day stay in the hospital, to possibly even same-day discharge – and decrease the amount of post-operative analgesia that patient will require."

Dr. Larry Demco: "Where do you see the future of laparoscopy going now? Is it a focus on the effects on the physician, or do you think it will now focus more on the effects to the patient?"

Dr. Patrick Osam: "I think it’s going to be a combination of both. We need to focus on the physician to educate those of us who have been trained on traditional 10-mm and 5-mm procedures in order to realize that we can accomplish the same operative procedure with 3-mm, and possibly 2-mm, instrumentation. Also, with patients being more informed by the Internet and having resources on patient education at their disposal, I think they are going to realize that these procedures are now available and seek out those physicians who are experienced, interested, and trained in these procedures."

Dr. Larry Demco: "I’d like to thank you, Dr. Osam, for sharing some of your ideas. I know being from Arkansas, you’re in the middle of the United States, and I’m glad to see that being in the middle doesn’t mean you’re at the end or at the beginning, and you’re trying to strive to reach new heights. So I’d like to thank you very much for your comments, and I hope to see you in the future, teaching with us on the Internet, and also at future meetings, perhaps as one of the faculty. Thank you."