1. Minimally invasive surgery describes a philosophical approach
to surgery in which access trauma is minimized without compromising
the quality of the surgical procedure.
2. Minimally invasive surgery is dependent upon videoscopic, ultrasonographic,
radiologic, and magnetic resonance imaging.
3. The carbon dioxide pneumoperitoneum used for laparoscopy induces
some unique pathophysiologic consequences.
4. Training for laparoscopy requires practice outside of the operating
room in a simulation laboratory and/or in animal models.
5. Laparoscopy during pregnancy is best performed in the second
trimester and is safe if appropriate monitoring is performed.
6. Laparoscopic surgery for cancer is also appropriate if good tissue
handling techniques are maintained.
7. Robotic surgery has been most valuable in the pelvis for performance
of minimally invasive prostatectomy and gynecologic and fertility
8. Natural orifice transluminal endoscopic surgery represents a
new opportunity to develop truly scar-free surgery.
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
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.
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.
Although the term minimally invasive surgery is