the
innovative LEDGER
An e-Newsletter from The Innovative Edge™ Inc.
Vol.
8, No. 4- April 2008
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Going Out Through the Door, Not the Wall
By Jeff Govendo
Let's
say you have an old sofa you're getting rid of. How would you want
to get it out of the house - carry it through an existing door or
window, or cut a hole through the wall and take it out through there?
Most
of us who are not particularly handy or looking for gigantic, expensive
repair projects would undoubtedly prefer the former method.
This
is precisely the thinking behind a new approach to surgical removal
of diseased internal organs called natural orifice translumenal endosurgery,
more commonly referred to as "scarless surgery." This
is not to be confused with minimally invasive techniques such as laparoscopy,
in itself far less traumatic than traditional incisional procedures.
In scarless surgery they actually go in - and come back out - through
existing bodily orifices (doors, windows -- get it? We'll keep
this at a metaphorical level), using a new generation of very flexible
instruments and cameras. There's little or no cutting, no stitching,
and almost no pain afterward. It also greatly reduces the risk of
infection or other complications, and nearly eliminates the recovery
period. Operations normally requiring several overnights can be done
on an outpatient basis.
To
date, scarless surgeries have been performed only about 60 times worldwide,
and only once in the U.S. In part, this is due to its relative
newness; the technique has been around about 4 years, done mostly
in India and South America.
Yet,
4 years isn't exactly "early experimental" either, and one
wonders why this innovative approach, with all its advantages, hasn't
been more widely practiced.
As
noted in a recent BusinessWeek article, the answer may lie in reasons
that have little to do with sound medical practice or patient-centeredness.
First, there is the rather conservative nature of the medical establishment.
Physicians tend to be a cautious lot (a good thing, by and large),
and slow to adopt radical new approaches, particularly ones that call
for them to change the way they do things they're very good at.
A
slightly more sinister reason is based on money. Scarless surgery,
for all its pluses, takes considerably longer. A skilled surgeon can
remove an appendix in minutes through an incision, whereas it might
take an hour or more using the...uh...door. Insurance companies, however,
pay a flat rate for appendix removal, no matter how it's done. So,
from a time management perspective, traditional surgery has a greater
ROI. Also, procedures that don't require overnight stays mean lost
revenue for the hospital.
This
does bring up an important aspect of innovation which is sometimes
overlooked: that it’s so much more than just the "invention"
itself that determines success. For instance, Thomas Edison is
commonly credited as the inventor of the light bulb, yet his invention
was preceded by others by decades. It was only because his team understood
the necessity of building the infrastructure to support the technology
and make it commercially viable, that it became widely accepted and
attributed to him. In the case of scarless surgery, that groundwork
might include wider availability of the types of instruments required,
better educating the public about the method, and of course, making
the financial case.
I
suspect that as the technique slowly gains credibility in the medical
establishment, and patients who note the advantages begin to demand
it, we will see much more scarless surgery being practiced in the
coming years. Until then, stay healthy, keep safe, watch your diet.
And
avoid drafts from your doors and windows
