TY - JOUR
T1 - Emerging Techniques in Minimally Invasive Surgery. Pros and Cons
AU - Fisichella, P. Marco
AU - DeMeester, Steven R.
AU - Hungness, Eric
AU - Perretta, Silvana
AU - Soper, Nathaniel J.
AU - Rosemurgy, Alexander
AU - Torquati, Alfonso
AU - Sachdeva, Ajit K.
AU - Patti, Marco G.
N1 - Publisher Copyright:
© 2015, The Society for Surgery of the Alimentary Tract.
PY - 2015/7/19
Y1 - 2015/7/19
N2 - New trends have emerged regarding the best minimally invasive access approaches to perform gastrointestinal surgery. However, these newer approaches are seen critically by those who demand a more strict assessment of outcomes and safety. An international panel of expert gathered at the 2014 American College of Surgeons Meeting with the goal of providing an evidence-based understanding of the real value of these approaches in gastrointestinal surgery. The panel has compared the efficacy and safety of most established approaches to gastrointestinal diseases to those of new treatment modalities: peroral esophageal myotomy vs. laparoscopic myotomy for achalasia, transgastric vs. transvaginal approach, and single-incision vs. multi-port access minimally invasive surgery. The panel found that (1) the outcome of these new approaches was not superior to that of established surgical procedures; (2) the new approaches are generally performed in few highly specialized centers; and (3) transgastric and transvaginal approaches might be safe and feasible in very experienced hands, but cost, training, operative time, and tools seem to limit their application for the treatment of common procedures such as cholecystectomy and appendectomy. Because the expected advantages of new approaches have yet to be proven in controlled trials, new approaches should be considered for adoption into practice only after thorough analyses of their efficacy and effectiveness and appropriate training.
AB - New trends have emerged regarding the best minimally invasive access approaches to perform gastrointestinal surgery. However, these newer approaches are seen critically by those who demand a more strict assessment of outcomes and safety. An international panel of expert gathered at the 2014 American College of Surgeons Meeting with the goal of providing an evidence-based understanding of the real value of these approaches in gastrointestinal surgery. The panel has compared the efficacy and safety of most established approaches to gastrointestinal diseases to those of new treatment modalities: peroral esophageal myotomy vs. laparoscopic myotomy for achalasia, transgastric vs. transvaginal approach, and single-incision vs. multi-port access minimally invasive surgery. The panel found that (1) the outcome of these new approaches was not superior to that of established surgical procedures; (2) the new approaches are generally performed in few highly specialized centers; and (3) transgastric and transvaginal approaches might be safe and feasible in very experienced hands, but cost, training, operative time, and tools seem to limit their application for the treatment of common procedures such as cholecystectomy and appendectomy. Because the expected advantages of new approaches have yet to be proven in controlled trials, new approaches should be considered for adoption into practice only after thorough analyses of their efficacy and effectiveness and appropriate training.
KW - Dor fundoplication
KW - Esophageal achalasia
KW - Laparoscopic Heller myotomy
KW - Laparoscopy
KW - Per oral endoscopic myotomy
KW - Pneumatic dilatation
KW - POEM
KW - Single-site surgery
KW - Transgastric access
KW - Transvaginal access
UR - http://www.scopus.com/inward/record.url?scp=84931562397&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84931562397&partnerID=8YFLogxK
U2 - 10.1007/s11605-015-2766-7
DO - 10.1007/s11605-015-2766-7
M3 - Article
C2 - 25678255
AN - SCOPUS:84931562397
VL - 19
SP - 1355
EP - 1362
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 7
ER -