The Laparoscopic Journey: Past and Future
The knowledge that we have today about laparoscopy has developed through the patience, hard-work and determination of dedicated doctors and individuals. When we started doing laparoscopic surgery, many doctors without laparoscopic training argued that open surgery had a better view through the large incision, than from the tiny camera’s panoramic view. They also thought that the sense of touch was lost by using instruments instead of fingers tips. They stated we were introducing unnecessary risks to any procedure by doing so. However, over time we have discovered that laparoscopic surgery is a very safe method. The view is much better with the cameras moving in all possible directions, and the tip of the instruments act as well as finger tips do after you have been trained to use the instruments.
We also were discouraged from performing laparoscopic surgery in the elderly, in the young and in the morbidly obese patients. The patients under this category were unable to have laparoscopic procedures of any kind in all major hospitals. However, time and experience have also demonstrated the safety of this technique for higher-risk patients. Now, everyone recognizes the laparoscopic method as the best option for many surgical procedures, and many people are now are surprised when procedures are not done using laparoscopy.
Advancement in the quality of lap band products has continued over the past 30 years. The first lap band model in the United States was the Inamed Lap Band, approved by the FDA in 2001. Doctors in the States began using this band as it was the only approved model in the US. We initially promoted another type of Lap Band that was developed in Europe, with a softer ring, and a bigger, low-pressure balloon to adjust to any stomach size. This type of Lap Band was approved by the FDA in 2006, and has now become the most widely used type of lap band in the world. A few years ago, this band was purchased by Johnson and Johnson and is now known in the US market as the Realize Band. Inamed (Now Allergan) has five different models of the Lap Band, which have been designed to emulate many of the characteristics of the Realize band.
Initially, there was much resistance against treating patients with a BMI less than 35, with bariatric procedures such as the Lap Band. The medical community now supports preventative medicine, by encouraging patients to be pro-active rather than waiting five or tens year and developing co-morbidities before they treat the medical problem. Today, there are various procedures acceptable for patients with a BMI of less than 35, including the Gastric Band, as well as more drastic procedures such as the Gastric Bypass, Duodenal Bypass, Gastric Sleeve and Duodenal Exclusion. These procedures are also helpful if you are looking for your patient to obtain the Metabolic Effect from these procedures, and to improve blood sugar control for patients with Type2 Diabetes, High blood pressure and High Cholesterol (Metabolic Syndrome).
Arturo Rodríguez, MD