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1. Minimally invasive surgery describes a philosophical approach to surgery in which access trauma is minimized without compromising the quality of the surgical procedure.

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2. Minimally invasive surgery is dependent upon videoscopic, ultrasonographic, radiologic, and magnetic resonance imaging.

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3. The carbon dioxide pneumoperitoneum used for laparoscopy induces some unique pathophysiologic consequences.

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4. Training for laparoscopy requires practice outside of the operating room in a simulation laboratory and/or in animal models.

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5. Laparoscopy during pregnancy is best performed in the second trimester and is safe if appropriate monitoring is performed.

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6. Laparoscopic surgery for cancer is also appropriate if good tissue handling techniques are maintained.

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7. Robotic surgery has been most valuable in the pelvis for performance of minimally invasive prostatectomy and gynecologic and fertility procedures.

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8. Natural orifice transluminal endoscopic surgery represents a new opportunity to develop truly scar-free surgery.

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Minimally invasive surgery describes an area of surgery that crosses all traditional disciplines, from general surgery to neurosurgery. It is not a discipline unto itself, but more a philosophy of surgery, a way of thinking. Minimally invasive surgery is a means of performing major operations through small incisions, often using miniaturized, high-tech imaging systems, to minimize the trauma of surgical exposure. Some believe that the term minimal access surgery more accurately describes the small incisions generally necessary to gain access to surgical sites in high-tech surgery, but John Wickham’s term minimally invasive surgery (MIS) is widely used because it describes the paradox of postmodern high-tech surgery—small holes, big operations—and the “minimalness” of the access and invasiveness of the procedures, captured in three words.

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Robotic surgery today is practiced using a single platform (Intuitive, Inc., Sunnyvale, CA) and should better be termed computer enhanced surgery as the term robotics assumes autonomous action that is not a feature of the da Vinci robotic system. Instead, the da Vinci robot couples an ergonomic workstation that features stereoptic video imaging and intuitive micromanipulators (surgeon side) with a set of arms delivering specialized laparoscopic instruments enhanced with more degrees of freedom than is allowed by laparoscopic surgery alone (patient side). A computer between the surgeon side and patient side removes surgical tremor and scales motion to allow precise microsurgery, helpful for microdissection and difficult anastomoses.

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Natural orifice transluminal endoscopic surgery (NOTES) is a recent extension of interventional endoscopy. Using the mouth, the anus, the vagina, and the urethra (natural orifices), flexible endoscopes are passed through the wall of the esophagus, stomach, colon, bladder, or vagina entering the mediastinum, the pleural space, or the peritoneal cavity. The advantage of this method of minimal access is principally the elimination of the scar associated with laparoscopy or thoracoscopy. Other advantages are yet to be elucidated, including pain reduction, need for hospitalization, and cost savings.

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Although the term minimally invasive surgery is relatively ...

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