Innovations in Endosurgery—Journey into the Past of the Future
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Progress in surgical practice has paralleled the civilizational evolution. Surgery has progressed from being the last resort in saving life to being form and function preserver. Post-renaissance Industrial age gave an impetus to this march of surgery. The currently on going digital technological revolution has further catalysed this march. Having achieved the stabilized and acceptable clinical outcomes, the surgeon has embarked on a journey of improving patient reported outcomes (PRO). Improvement in PROs with the advent of laparoscopic surgery with the attendant emphasis on minimising invasion has led to debates about invasion being just parietal or holistic in physiological sense. There is a concern that parietal invasiveness shouldn’t be a trade-off for compromised clinical outcomes. Single Incision Laparoscopic Surgery (SILS) in its current avatar with current instrumentation seems to be an enthusiastic bandwagon rolling on with the cosmetic benefits acting as veil to hide the potential clinical concerns. History of surgical innovations is riddled with tales of vindictiveness and vicissitude. Lest the same fate befalls SILS we would do better to examine the SILS bandwagon in its current form till the emerging technologies address the current concerns.
KeywordsSingle incision laparoscopic surgery (SILS) Reduced port surgery Innovations in surgery Patient reported outcomes Informed consent Metric of innovation History of innovations
We are grateful to Ms Ramneek Kaur, Krishna Adit and Nayan Agarwal for their valuable help in documentation and preparation of manuscript.
The authors have taken SILS as representing a truly single Incision Laparoscopic Surgery and not the usually practiced ‘Reduced Port Surgery’ (RPS) that is erroneously confused with SILS by some. Scientifically even a single trans-parietal suture puncture negates the concept of SILS. The authors practice RPS by routinely using a single 10 mm umbilical port supported by two or three 2.7 mm to 3.5 mm working ports for laparoscopic cholecystectomies etc.
- 41.Bencsath KP, Falk G, Morris-Stiff G, Kroh M, Walsh RM, Chalikonda S (2011) Single-incision laparoscopic cholecystectomy: do patients care? J Gastrointest Surg 29Google Scholar
- 43.Cheerleader or watchdog? [No authors listed] Nature 2009 25;459:1033Google Scholar
- 47.(1991) A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club. [No authors listed]. N Engl J Med 324:1073–1078Google Scholar
- 65.Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P et al (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24:1842–1848PubMedCrossRefGoogle Scholar
- 71.Bencsath KP, Falk G, Morris-Stiff G, Kroh M, Walsh RM, Chalikonda S (2012) Single-incision laparoscopic cholecystectomy: do patients care? J Gastrointest Surg 16(3):535–539Google Scholar
- 75.Ioannidis JP (2010) Lies, damned lies, and medical science. The Atlantic November, 2010. Available from: http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-cience/8269/ [Last accessed on 19 December 2011]
- 79.Krugman P (2011) Patients are not consumers. The New York Times, April 21, 2011. Available from http://www.nytimes.com/2011/04/22/opinion/22krugman.html [Last accessed on 19 December 2011]
- 80.Hey J, Roberts KJ, Morris-Stiff GJ, Toogood GJ (2012) Patient views through the keyhole: new perspectives on single-incision vs.multiport laparoscopic cholecystectomy. HPB (Oxford) 14:242–246Google Scholar