Surgical Innovation

The author draws on the experience with a large privately owned freestanding surgery center to extract some principles that were felt to contribute to the growth and financial success of the center. Identifying the desired outcomes and the core processes that implement and facilitate those outcomes is critical. Concentration on these creates true value from the perspective of the patient, the physician, and the investor. This process, if implemented fully, affects everything from the architectural design of the entire building to the design of an individual operating room and the operational processes necessary to provide services. This process also has applicability to minimally invasive surgery because the rapid adaptation of more complex procedures to the outpatient environment, the interplay between expensive capital and equipment expenditures, and the reimbursement issues affects the growth of minimally invasive surgery in an ambulatory surgery center. This provides a unique opportunity to also rethink the ergonomic and design considerations of minimally invasive surgery. Copyright © 1999 by W. B. Saunders Company

Laparoscopic surgery has revolutionized the outpatient surgery industry by increasing the types of surgical cases that can be performed on an outpatient or extended recovery basis. This article examines the economics surrounding laparoscopic surgery by discussing operational considerations as they relate to the surgical delivery of care. Methodologies for basic analysis of the financial impact of instituting or upgrading laparoscopic capabilities are presented for the physician's understanding of how technology affects an ever-shrinking base of reimbursement. Proposals by the Health Care Financing Administration in redesigning reim_ _ bursement for outpatient surgery services provided to Medicare beneficiaries are critically important in health care delivery because the growth in the over 65 group will soon be touched by the first of the baby-boomers. Finally, examples of various studies examining the significant direct costs for benchmarking and the advantages of laparoscopy as a surgical technique are presented. Copyright © 1999 by W B. Saunders Company

Laparoscopic procedures are becoming routine and commonplace. Patients who undergo laparoscopic surgery enjoy shorter hospital stays and quicker recovery times. These procedures have naturally progressed to an ambulatory status. Their spectrum is continually expanding. Also, the trend towards shorter hospital stays, in part driven by the advent of laparoscopic procedures, may alter traditional surgical dogma regarding length of stay. Copyright © 1999 by W B. Saunders Company

Minilaparoscopy is an emerging aspect of laparoscopic surgery involving the use of miniaturized scopes and instruments to further reduce perioperative morbidity and enhance cosmesis. Recent improvements in optical technology and instrument design have enabled relatively broad applications of minilaparoscopy to include diagnostic and therapeutic procedures in both inpatient and outpatient settings. Early results suggest that minilaparoscopic procedures in the hands of experienced laparoscopic surgeons appear to be similarly safe and effective with minimally perceptive scarring. Although promising, clear advantages in reducing perioperative pain and morbidity have yet to be determined. Copyright © 1999 by W. B. Saunders Company

Laparoscopy is increasingly being used as a diagnostic technique to characterize intraperitoneal processes. This technique can be highly informative when applied in settings such as the intensive care unit, the emergency room, the trauma bay, and the office. Diagnostic laparoscopy is an excellent method to evaluate intraperitoneal processes and should be part of the general surgeon's armamentarium of skills. In this paper, the technique of diagnostic laparoscopy and its role outside of the operating room setting is reviewed. Diagnostic laparoscopy is also compared with other diagnostic modalities. Copyright© 1999 by W. B. Saunders Company