title: Minimally invasive surgery in gastrointestinal cancer: benefits, challenges, and solutions for underutilization.
abstract: OBJECTIVE
  After the widespread application of minimally invasive surgery for benign diseases and given its proven safety and efficacy, minimally invasive surgery for gastrointestinal cancer has gained substantial attention in the past several years. Despite the large number of publications on the topic and level I evidence to support its use in colon cancer, minimally invasive surgery for most gastrointestinal malignancies is still underused.
  
  
  METHODS
  We explore some of the challenges that face the fusion of minimally invasive surgery technology in the management of gastrointestinal malignancies and propose solutions that may help increase the utilization in the future. These solutions are based on extensive literature review, observation of current trends and practices in this field, and discussion made with experts in the field.
  
  
  RESULTS
  We propose 4 different solutions to increase the use of minimally invasive surgery in the treatment of gastrointestinal malignancies: collaboration between surgical oncologists/hepatopancreatobiliary surgeons and minimally invasive surgeons at the same institution; a single surgeon performing 2 fellowships in surgical oncology/hepatopancreatobiliary surgery and minimally invasive surgery; establishing centers of excellence in minimally invasive gastrointestinal cancer management; and finally, using robotic technology to help with complex laparoscopic skills.
  
  
  CONCLUSIONS
  Multiple studies have confirmed the utility of minimally invasive surgery techniques in dealing with patients with gastrointestinal malignancies. However, training continues to be the most important challenge that faces the use of minimally invasive surgery in the management of gastrointestinal malignancy; implementation of our proposed solutions may help increase the rate of adoption in the future.
authors.affiliation: Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Osama H
authors.initials: OH
authors.lastname: Hamed
authors.affiliation: Department of Surgery, Penn State Cancer Center, Hershey, PA, USA.
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Kimchi
authors.affiliation: Department of Surgery, University of Maryland, Baltimore, MD, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Kavic
mesh_terms: D005544:Forecasting; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000639:trends; D019060:Minimally Invasive Surgical Procedures / Q000639:trends*; D012371:Robotics
keywords: MIS; MIS Underutilization; MIS benefits; Minimally Invasive Surgery in GI Cancer