Comments of the Surgeon

On average, how long do you take to perform an operation with the LESS method when directly compared to the same operation with the open method, provided that there are no complications?
The duration of surgery has levelled off at that of a comparable classical laparoscopic method. More and more, an open procedure is only performed in special situations. With the same safety and feasibility, however, a more gentle, minimally invasive procedure (LESS, classic laparoscopy) is the method of choice. 

Is it possible to give a patient less anaesthetics before LESS surgery than before open surgery?
There is only a difference at the beginning of the intervention, because bigger cuts into the abdomen require more anaesthetics to suppress the pain than with the LESS method.

How often do you encounter complications during LESS surgery that requires you to make an ad hoc decision to switch to open surgery, or create an additional access?
To create one or two additional access sites during a LESS intervention is not regarded as a complication but rather as a prudent decision in difficult operational situations. In such a case, the patient still benefits from the minimally invasive approach. Switching to the open method can also become necessary for safety reasons if there are complex intra-operative results. In fact, the planned LESS method can be executed in more than 90% of the operations performed by experienced surgeons. Switching to the open technique occurs in less than 1%.

What is your estimation of the post-operative pain patients experience when undergoing conventional open surgery compared to LESS surgery?
LESS surgery leads to a reduction of pain in comparison to open surgery. However, currently there is only adequate scientific proof for this benefit in classical laparoscopy.

Do you give less post-operative pain medication to patients who have undergone LESS surgery?
Compared to open surgery, these patients need less pain medication. 

How many and what kind of LESS procedures have you already performed?
So far, patients with benign and malignant diseases of the oesophagus, stomach, intestine, gall bladder, liver, pancreas, spleen and adrenal gland as well as patients with inguinal hernia, abdominal wall hernia or obesity have undergone surgery at the Department of Surgery of the Krankenhaus der Barmherzigen Brüder in Salzburg, Austria. There have been more than 600 LESS operations in total. Our department is regarded as one of the centres of excellence in the field of modern minimally invasive surgery.

LESS surgery can be employed in fields like urology, gynaecology and general medicine. In the future, do you think the LESS procedure will be defined as the gold standard for specific indications or specific operational procedures?
The next few years will answer those questions. Progress in surgery will definitely be made through the LESS approach.