Technology for minimal access surgery

doi:10.1136/bmj.319.7220.1304

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Alfred Cuschieri (a.cuschieri@dundee.ac.uk)

One of the important changes in medical practice over the past two decades has been the reduction in traumatic insult inherent in surgical interventions. The new surgical and interventional approaches are usually referred to as minimally invasive. However, this terminology is inappropriate for two reasons. Firstly, it carries connotations of increased safety, which is not the case. Secondly, it is semantically incorrect since to invade is absolute, and indeed such interventions are as invasive as open surgery in terms of reach of the various organs and tissues. The hallmark of the new approaches is the reduction in the trauma of access. Hence, a more appropriate generic term is minimal access therapy.1

Summary points

Minimal access therapy comprises minimal access surgery, interventional flexible endoscopy, and percutaneous interventional radiology

The main advantage is reduced trauma of access, which allows more rapid recovery

Imaging systems which allow surgeons to look down on the operating field help overcome mapping problems and improve performance

New instruments are being developed that give surgeons greater freedom of movement

Operating theatres need to be specially designed to cope with the new equipment

What is minimal access therapy?

Minimal access therapy comprises several approaches, involves various disciplines, and cuts across the various specialties within these disciplines. In essence, however, it has three arms: minimal access surgery, interventional flexible endoscopy, and percutaneous interventional radiology. These therapeutic approaches are largely complementary, and increasingly they are used together to treat individual cases. The advent of minimal access therapy has emphasised the need to regroup existing specialists from different disciplines to form multidisciplinary disease related treatment groups—for example, gastrointestinal, cardiovascular, or musculoskeletal groups. Such groups would facilitate real progress and efficiency in management and treatment of many diseases.

Minimal access therapy aims to minimise the traumatic insult to the patient without compromising the safety and efficacy of the treatment …