Surgery Without the Slicing

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Dr. Talamini extols the highly accelerated recovery time Brad Swonetz/Redux

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Surgeons can be a conservative lot, however. Winning them over to scarless surgery is likely to take years, judging from the long, slow adoption of minimally invasive techniques. Although gallbladder removals and acid reflux repairs are almost all done laparoscopically these days, only 15% of hysterectomies are minimally invasive, and 25% of hernia repairs.

The problem boils down to cost—not for the patient, but for the doctor. Minimally invasive operations can take twice as long as standard surgery, and doing the same procedure without any outer incisions will slow the process further. But insurers pay the same amount for an operation no matter how long it takes. Shorter recoveries also mean lost revenue for hospitals. As noted in one Israeli study of the costs and benefits of minimally invasive surgery: "Hospitals have no economic incentive to adopt the laparoscopic technology as benefits occur only in society."

Customer demand could change all that. A small patient survey by Dr. Nathaniel Soper, an expert on minimally invasive surgery at Northwestern Memorial Hospital in Chicago, found that the majority would choose a scarless approach if assured the procedure was safe.

Instrument manufacturers are eager to develop safer tools. Ethicon Endo-Surgery, a Johnson & Johnson (JNJ) unit and the leader in the $15 billion market for minimally invasive instruments, is donating money to surgical societies to advance research into scarless procedures and funding further development in-house. There are also startups such as Austin (Tex.)-based Apollo Endosurgery, which grew out of a scarless surgery collaboration among surgeons at several different hospitals. Says Apollo CEO Dennis McWilliams: "The venture capital community is very interested in NOTES because it sees a multibillion-dollar market that is finally opening to competition."

Join a debate about the Riegel v. Medtronic decision on medical devices.

Arnst is a senior writer for BusinessWeek based in New York.