title: Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.
abstract: 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.
authors: Department of Surgery, Brigham and Women's Hospital and Boston VA Healthcare System, Harvard Medical School, 1400 VFW Parkway, West Roxbury, Boston, MA, 02132, USA, marco6370@yahoo.com.
authors: P Marco
authors: PM
authors: Fisichella
authors: Steven R
authors: SR
authors: DeMeester
authors: Eric
authors: E
authors: Hungness
authors: Silvana
authors: S
authors: Perretta
authors: Nathaniel J
authors: NJ
authors: Soper
authors: Alexander
authors: A
authors: Rosemurgy
authors: Alfonso
authors: A
authors: Torquati
authors: Ajit K
authors: AK
authors: Sachdeva
authors: Marco G
authors: MG
authors: Patti
mesh_terms: D001062:Appendectomy / Q000379:methods / Q000639:trends; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000639:trends; D003226:Congresses as Topic; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000639:trends; D004931:Esophageal Achalasia / Q000601:surgery; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods / Q000639:trends; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods / Q000639:trends; D061646:Operative Time