The “Straw Man” Is Back

A rather breathless posting on Science Daily today extols the virtues of the “scarless” or single incision laparoscopic cholecystectomy compared to the standard four small incision technique. Single incision, or laparoendoscopic single-site surgery [abbreviated LESS (a catchy acronym is mandatory)], utilizes one incision in the navel through which the entire surgical dissection and removal of the gallbladder are done. LESS cannot usually be done when the surgery is for an acute gallbladder attack or if the patient has had previous upper abdominal surgery. The study was done at Mt. Sinai Hospital in New York.

According to the article “The Mt. Sinai group did find two advantages to the LESS procedure: these patients required less pain medicine after the operation than their counterparts who had the traditional minimally invasive operation; and LESS patients typically reported higher satisfaction scores: —4.7 on a scale of 1 to 5 (5 equals highest score) versus 3.6 for the conventional laparoscopic surgery group.”

Available in the abstract of the paper but not reported by Science Daily were the following: the study was retrospective and involved only 26 LESS patients and 50 conventional laparoscopic cholecystectomy patients; 31% of the LESS patients required additional incisions; the average age of the LESS patients was significantly younger than the conventional group [37 vs. 49 years respectively]; follow-up data were unavailable for over half of the conventional group.

The Science Daily piece quotes one of the authors. "What's really exciting is how these patients would recommend the procedure to a friend or family member," Dr. Chin said. "Seventy-four percent of the patients who had the single-incision operation would strongly recommend the procedure to someone else versus 36 percent of those who had laparoscopic surgery."

Here is where the “straw man” is introduced. A “straw man” is defined [see The Skeptic's Dictionary] as creating a fallacious argument and then refuting it with one’s own position. If you believe this article, only 36% of those who had standard four-incision laparoscopic surgery would recommend it to someone else. However, in the early days of laparoscopic cholecystectomy, papers reported patient satisfaction rates of 94-95% after conventional laparoscopic cholecystectomy.

Patients in both groups had obviously undergone only one of the two procedures making the recommendation data rather difficult to interpret. If 64% of patients who had undergone conventional laparoscopic cholecystectomy would not recommend it to someone else, what then would they recommend? Keep your gallbladder despite the pain? Old fashioned large incision open surgery? Suicide?

The straw man is an old friend. It’s good to see that he is still around.