Research in Endoscopic Surgery

Abstract

ABSTRACT

Major breakthroughs in surgery have come about by just doing it. Without proper evaluation, however, one can not be sure whether a new technique is superior. Concerning endoscopic surgery, several fields are under investigation at the same time. This presentation deals with the fields of ergonomics and technology assessment. Endoscopic surgery is more difficult than classic open surgery because the surgeon faces many restrictions. Ergonomics learns how to deal with these. As a result, endoscopic surgery becomes less difficult, less fatiguing, and faster, making it easier for the surgeon and therefore safer for the patient. Moreover, a standardized model, which has incorporated the results of ergonomic studies, is a prerogative for solid research. Technology assessment includes four steps: (1) feasibility and safety, (2) efficacy, (3) efficiency, and (4) cost-benefit ratio. Most of the studies done so far have dealt only with feasibility, and most of the classic open operations can now be performed endoscopically. But what about safety? There is the problem of the learning curve. The CO2 pneumoperitoneum is invasive, some of its effects being augmented by patient positioning. There are also the hazards of using energy-applying systems in a closed environment. As far as efficacy is concerned, there is a general lack of prospective randomized studies showing that endoscopic surgery is superior. Also regarding efficiency, not much research has been carried out. As far as cost-benefit ratio is concerned, most studies take for granted that the final results of an open operation and a similar endoscopic operation are the same. Whether this is true remains to be proved. Generally, operating room costs are higher for endoscopic procedures, but overall costs are lower because of the shorter hospital stay and a more rapid return to work. In children, the benefit of endoscopic operations should rather be expressed in terms of quality of life. According to both common sense and research, "the less invasive the better." But how should invasiveness be defined? Invasiveness is a sum of many factors: length of the incision, way of maintaining exposure (retraction or CO₂ pneumoperitoneum), amount of tissue handling inside the cavity to be operated on, nature of the operation itself, length of the procedure. Endoscopic surgery is more difficult than open surgery. This demands additional training and more innate abilities. The results of research in the field of ergonomics should be universally applied. This will make the procedures easier and faster and will therefore increase safety and decrease invasiveness. Also, further technical improvements will make endoscopic operations simpler, safer, and less invasive. The eruption of the endoscopic surgical volcano has changed surgical thinking. Now we think in terms of overall invasiveness, trying to identify and control the contributing factors.