So you think that little video camera in your closet is a marvel of miniaturization? Imagine trying to stick it through your navel.
In what has become common procedure, doctors are performing surgery by viewing their patients' innards through a skinny video tube -- a laparoscope -- and by poking long-handled scalpels through a few half-inch slits in the belly.
Although the procedure is nothing new in gynecological surgery, it began getting popular for general surgery in 1989, says Dr. Mark A. Talamini, a Johns Hopkins University surgery professor. "Then it became wildly popular in 1990," he says.
"The benefits to patients are many," says the doctor who also heads the hospital's minimal invasive surgery department.
"It significantly reduces pain and disability. Plus, the patients are out of the hospital quicker." But, he says, there could be disadvantages. "It depends on the procedure." And the cost is sometimes higher than for conventional surgery.
There's hardly any organ, from the breast to the appendix to the colon, that isn't a laparoscopic frontier for an imaginative surgeon.
"There's no big rule that says you can do this or you can't," says Dr. Norman Halpern, a surgery professor at the University of Alabama and a leader in setting voluntary standards for laparoscopy.
The laparoscope is expected to be used this year in an estimated 600,000 gallbladder operations, 120,000 hernia repairs, 125,000 hysterectomies and countless other operations nationwide. It's a mushrooming field, but the buyer still needs to beware, doctors say.
"Patients should not be afraid when they meet their surgeon to ask, 'Well, how many of these have you done? What type of training did you have to do this?' And then the big thing is, 'How many complications have you had and what are they?' " says Dr. David Edelman, a surgeon at Baptist Hospital in Kendall, Fla.
The answers are important because -- unlike a new drug or medical device that needs federal approval -- a surgeon can perform any operation in any way he or she judges best. So, while laparoscopy gives patients more and often better choices, it also means deciding whether to be a guinea pig for unproved techniques.
Recently, the American Medical Association released a report stating that the availability of the laparoscopic surgery is tied to an increase in gallbladder surgery.
"The introduction of laparoscopic gallbladder surgery . . .," writes Dr. Antonio P. Legorreta and colleagues, "has climbed from 0 percent in 1987 to 80 percent in 1992."
Some doctors say the increase is for no better reason than because it's new technology that everyone wants to use.
Hopkins surgeon Dr. Talamini agrees the procedure has initiated more gallbladder surgeries.
"There is no question more gallbladder surgeries have been done since the advent of this surgery. But the question is what is necessary," he says.
"Before [laparoscopic surgery] you would have had a big, slash on your belly, a big scar and a longer hospital stay," he says.
People would be willing to tolerate severe symptoms before deciding on such disruptive surgery.
Laparoscopy dramatically lessens the severity of the after-effects and that would explain some of the increase, Dr. Talamini says.
"It was the most fantastic thing I've ever experienced," says Anita Melnick of Aventura, Fla., who had her gallbladder removed -- the most common use of laparoscopy.
Quick surgery, quick recovery
This hollow organ on a person's right side, just under the liver, stores bile until the stomach needs it to digest fats.
About 650,000 people every year have their gallbladders removed because of painful gallstones. Conventional surgery requires up to eight days in the hospital and four to six weeks of recovery.
"I went in at 1 o'clock on a Wednesday. At 12:30 the next day I'm in my apartment, having a breakfast of eggs and muffin and juice and home fries. By Saturday and Sunday, my husband and I went out to dinner," Ms. Melnick says. "I just can't recommend it enough. It's incredible."
Laparoscopy also spared her from the six-inch incision that President Lyndon Johnson proudly displayed for the press when he had his gallbladder surgery in the 1960s.
It was around that time that the real pioneers of laparoscopy, gynecologists, were gaining experience with a primitive forerunner to today's laparoscope. This single eyepiece atop a viewing tube allowed one person at a time to look through a lens into the body.
"I've been doing it since 1970,"says Dr. Bernard Cantor, chairman of obstetrics and gynecology at Mount Sinai Medical Center in Miami. "And, for the first maybe 15 to 18 years, it was primarily for diagnostic procedures."
Everything looked small and blurry through these early machines, Dr. Cantor says. Then the same video revolution that brought feature films to our living rooms changed all that, he said.