New devices and technologies are making abdominal surgery easier, safer and more efficient than ever before. From better treatment options for obese patients to an impending influx of surgical robots, we talked to the experts to find out their thoughts on these 5 abdominal surgery trends.

1 Mini-lap's changing role
While mini-laparoscopy was thought to be the next big thing in laparoscopy, surgeons we talked to say its appeal has diminished somewhat.

"It's not the rage right now," says Daniel Jones, MD, FACS, chief of minimally invasive surgical services at Beth Israel Deaconess Medical Center in Boston, Mass. "There was a lot of interest before, but it's since waned. Having 2-mm holes looks nicer, but most people think, 'Let's save that healthcare dollar.'"

Though some say mini-lap has several potential advantages over laparoscopy, including less post-op pain and fewer complications, Dr. Jones notes that mini-lap's biggest draw may be cosmetic — a smaller incision size that means minimal scarring. Because of this, he notes, the technique is taking off in facilities located within highly competitive markets "where they're not as sensitive to costs."

However, certain procedures done with mini-lap can actually end up saving a facility money, says Aurora D. Pryor, MD, professor of surgery and vice chair for clinical affairs at Stony Brook (N.Y.) School of Medicine. Some mini-lap systems require fewer disposable devices for each case, depending on the manufacturer. "Some of these devices have reusable ports or they don't need a port because it's inserted through the skin," she says. "That can end up saving money over conventional laparoscopy."

Mini-lap can also reduce pain and the risk of hernia following surgery, adds Dr. Pryor. It's easy to add to a facility, too, especially with updated systems featuring sturdier handles, ergonomic grips and more effective working tips. "The technique is so similar to laparoscopy. The surgeon is just using smaller instruments," says Dr. Pryor. "Anything you can do laparoscopically, you can do with mini-lap."

ROOM TO GROW More general surgeons are looking at surgical robots as a way to tackle notoriously difficult abdominal procedures.

2 Improved surgical video technology
Surgical video is "always evolving," says Dr. Jones, and the latest 3D, 4K and image enhancement systems are designed to give your docs superior visualization during abdominal surgery. The biggest advance today is 4K, says Dr. Pryor. She notes that the technology, which has 4 times the resolution and more intense colors than standard 1080p HD systems, has the potential to boost patient outcomes. "Any time you see better, it will potentially improve patient safety," says Dr. Pyror.

Another option taking hold is 3D technology. Surgeons can opt for 3D views in 2 forms: robots equipped with 3D video and standalone systems where viewers wear 3D glasses. 3D systems give surgeons better depth perception during procedures, which can be especially helpful for such tasks as suturing or separating layers of tissue, says Dr. Pryor.

For those who want their images to do more, image enhancement systems go beyond higher resolution or improved depth perception. This category includes optical enhancement systems like narrow band or fluorescence imaging, which use either injected dye or filtered light to show contrast-enhanced views of the surgical surface. Another technology uses digital processors to cut through smoke and fog, intensify colors and sharpen images.

Dr. Pryor has tried fluorescence imaging technology that requires you first to inject the patient with an indocyanine green solution. Using the image enhancement system, you can switch the video from standard white light to fluorescence imaging during the procedure. The green dye lights up certain anatomical features, letting you "see bile ducts and blood vessels more easily," says Dr. Pryor, which could "cut down on complications and improve patient safety."

TINY CUTS Though mini-lap may not be as popular as it once was, some surgeons still feel that its smaller incisions could help improve outcomes.

3 Less-invasive weight loss
A few new technologies aim to make bariatric surgery less invasive:

• A pump that dumps. AspireAssist is an external stomach pump that dumps part of the stomach contents into the toilet. Surgeons insert the device during a simple 15-minute procedure under conscious sedation. Dr. Pryor calls the technology "an exciting addition to what we can already do in bariatric surgery," says Dr. Pryor.
• Gastric balloons. The Elipse is a procedureless gastric balloon that comes in a capsule that patients swallow. The capsule is attached to a thin swallowable catheter that's long enough so that once the capsule degrades inside the stomach, you can fill the ballon with fluid from outside the mouth. After the balloon is filled, you detach the catheter and remove it from the mouth. About 4 months later, the balloon deflates and passes into the toilet.

"For patients trying to lose 100 or more pounds, it's not likely the best choice," says Dr. Jones. "But for those who want to lose some weight but aren't qualified for normal gastric bypass or the sleeve, the technology may work nicely."

The ReShape Dual Balloon is endoscopically inserted into the stomach and filled with saline. The balloon remains in the stomach for 6 months and helps reduce hunger.

4 Modern hernia mesh
There is no one perfect hernia mesh, but manufacturers are trying to expand your options and offer more meshes to fit a larger variety of cases and budgets.

While surgeons often want to use pricey biologics in cases where there's a high risk of infection, several new synthetic alternatives are designed to help the fixed hernia heal while minimizing complications. Bio-absorbable meshes, traditionally used in trauma surgery, are now designed to be lighter and work in cases where there's a greater risk of infection. The body gradually absorbs these meshes over several months, and some preliminary research shows that they can treat high-risk hernias just as well as biologic mesh, at a much lower cost. (osmag.net/TNn6Vh).

Taking that a step further are hybrid meshes, says Dr. Pryor. These meshes combine the stability of a permanent, polypropylene mesh with the biologic/bio-absorbable's promotion of tissue growth. In these designs, a permanent synthetic mesh is coated with either a biologic or bio-absorbable coating. They tend to work best in contaminated and some clean-contaminated cases, she says, though initial research hasn't yet proven their advantages over standard mesh.

"We're still trying to figure out exactly how to use it and what it works best for," says Dr. Pryor, "but I am interested in seeing its potential."

5 New, easy-to-use robots
Surgical robots are becoming more mainstream in several specialties, though their use in abdominal surgery has traditionally been slow. But new updates as well as the promise of more robots entering the market could open up the technology to new users in abdominal surgery.

"Until recently, most surgeons thought that there weren't any demonstrated advantages for the robot's use in abdominal surgery," says Dr. Jones. "But as more surgeons adopt the technology, they are seeing some advantages, like that they don't need their surgical assistants and that they have improved case efficiency."

Dr. Pryor says robots are particularly useful in abdominal wall reconstruction, "which is a very hard procedure to do laparoscopically, but with the robot's articulated instruments you can get much better angles."

With new manufacturers poised to enter the market in the coming years, the hope is that increased competition will drive down prices and make the robots more accessible. Still, Dr. Jones says that general surgeons aren't clear where robotic procedures have the biggest advantages over open or laparoscopic techniques.

"We haven't worked out the where and for whom it makes the biggest impact," he says. "But it isn't too far of a stretch to say that its highly motorized movements, better visualization and articulated instruments could benefit some procedures." OSM