title: Innovations in minimally invasive surgery: lessons learned from translational animal models.
abstract: OBJECTIVE
  Animal models are key elements of surgical research and promotion of new techniques. Inanimate models, anatomical specimens, and living animals are all necessary to solve the various problems encountered by the advent of a new surgical technique. The development of Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedures is a representative model.
  
  
  METHODS
  Over 400 experimental procedures were performed in inanimate models, ex vivo tissues and animals to solve all problems faced by the development of NOTES surgery: peritoneal access, gastrotomy closure, exposure, retraction, dissection as well as education to start this new procedure.
  
  
  RESULTS
  The successive use of all models allows to identify the ideal solution for each problem and to precisely define the safest and most reliable option to apply the new technique in patients. It allowed to perform the first transvaginal and transgastric cholecystectomy in patients in a safe way.
  
  
  CONCLUSIONS
  Animal experimentation remains necessary as even sophisticated computer-based solutions are unable to model all interactions between molecules, cells, tissues, organisms, and their environment. Animal research is required in many areas to validate new technologies, develop training, let alone its major goal (namely to avoid using patients for experimentation) which is to be the first "model" for the surgeon.
authors.affiliation: Department of Digestive and Endocrine Surgery, IRCAD/EITS, IHU, University Hospital of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France, didier.mutter@ircad.fr.
authors.forename: D
authors.initials: D
authors.lastname: Mutter
authors.forename: B
authors.initials: B
authors.lastname: Dallemagne
authors.forename: S
authors.initials: S
authors.lastname: Perretta
authors.forename: M
authors.initials: M
authors.lastname: Vix
authors.forename: J
authors.initials: J
authors.lastname: Leroy
authors.forename: P
authors.initials: P
authors.lastname: Pessaux
authors.forename: J
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000818:Animals; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D023421:Models, Animal; D057170:Translational Research, Biomedical
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