Recent advances in minimal access surgery

doi:10.1136/bmj.324.7328.31

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Ara Darzi (a.darzi@ic.ac.uk), professor of surgery and head of department,
Sean Mackay, research fellow

Academic Surgical Unit, Imperial College of Science Technology and Medicine, St Mary's Hospital, London W2 1NY

Correspondence to: A Darzi

Minimally invasive surgery is the most important revolution in surgical technique since the early 1900s. Its development was facilitated by the introduction of miniaturised video cameras with good image reproduction. Laparoscopic cholecystectomy was the first procedure to be widely accepted, and several others are now well established. Other procedures are being validated, but further use of the technique may partly depend on the development of new enabling technologies. For example, a virtual reality laparoscopic simulator was recently used to assess the value of a three dimensional laparoscopic camera system.1 We present an overview of advances in minimal access surgery, concentrating on procedures that have most recently become established in everyday surgical practice.

Methods

We selected the topics to be discussed after consultation with the other surgeons in our department. We then conducted a literature search (Medline 1993-2000) separately for each section of the paper. Because of the broad nature of the topics covered, we have generally cited good quality reviews rather than the original papers.

Technological sea change

Laparoscopy has been well established in gynaecology for many years, but the technique was adopted much more slowly in surgery. This is mainly because of the early limits of the technology. Gynaecologists used a purely optical telescope for illumination and visualisation and operated unassisted. With one hand on the telescope, the gynaecologist had only one hand to manipulate the viscera, and thus the technical repertoire was limited.

The development of miniaturised television cameras that give an adequate image was key in the minimal access revolution. It allowed the assistant to have the same view as the surgeon. The assistant could therefore hold the camera (allowing the surgeon to operate with two hands) and retract the viscera to improve the access. Laparoscopic cholecystectomy was soon shown to be possible, and rapidly became the procedure of choice. …