Education And Debate

Minimally Invasive Surgery: Future developments

BMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6922.193 (Published 15 January 1994) Cite this as: BMJ 1994;308:193
  1. J E A Wickham
  1. Department of Minimally Invasive Therapy, Guy's Hospital, London SE1 9RT.

    The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of alave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introduced into body cavities to perform operations that are currently impossible. New materials will allow changes in instrument construction, such as use of memory metals to make heat activated scissors or forceps. With the reduced trauma associated with minimally invasive surgery, fewer operations will require long hospital stays. Traditional surgical wards will become largely redundant, and hospitals will need to cope with increased throughput of patients. Operating theatres will have to be equipped with complex high technology equipment, and hospital staff will need to be trained to manage it. Conventional nursing care will be carried out more in the community. Many traditional specialties will be merged, and surgical training will need fundamental revision to ensure that surgeons are competent to carry out the new procedures.

    For the past 150 years mortality and morbidity for all surgical operations have been tacitly accepted as unavoidable parts of the therapeutic process, but since the early 1980s it has become evident that less invasive methods of interventional treatment in some areas have produced far fewer complications with a reduced risk of death and morbidity.1 This realisation has given rise to the idea of minimally invasive treatment with its general aim “to minimise the trauma of any interventional process but still achieve a satisfactory therapeutic result.”2,3 More and more surgical and radiological procedures are being re-evaluated worldwide with a view to reducing operative trauma.

    In the …

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