The Current State of Minimally Invasive Surgery

Patients and their families are usually thrilled to hear than a child's needed surgery can be doneusing minimally invasive means, said Hanmin Lee, MD, Associate professor of pediatric surgery at theUCSF Children's Hospital.

This is no surprise, Dr. Lee said during the opening plenary session on Saturday, at theAAP's National Convention and Exposition in his hometown of San Francisco. Besides leaving a smallersurgical scar, there is less pain, fewer alterations, shorter hospital stays, and even lessadhesions.

There are even advantages for the OR team doing the surgery. Everyone sees the same view viathe small tubed camera, and the view is greatly magnified, leading to better teaching.

But there are drawbacks. Not everyone has the competence of using such tools, which are quitedifferent from traditional surgical tools. Only one person can perform the surgery, minimizingteaching opportunities. And with all new techniques, there are new ethical questions to consider.The biggest disadvantage, though, is in scholarship. With only around 600 pediatric surgeons, thereis simply not enough data from existing surgeries to get the 500 case studies for a clinical trialwith a high N value.

Dr. Lee compared traditional and minimally invasive surgical tools to eating with forks orchopsticks. Most surgeons were trained with forks, and are now being introduced to the more delicateand precise chopsticks. Newer residents, however, are learning on chopsticks.

Even for one on the cutting edge of new techniques, Dr. Lee has contemporaries who herespectfully called "maniacs." For instance, those who follow the "NOTES" philosophy of minimallyinvasive surgery - NOTES stands for "natural orifice transluminal endoscopic surgery." NOTESsurgeons locate surgical openings only in existing body cavities - the mouth, the anus,etc.

The biggest needs for the future of MIS, Dr. Lee said, were substantial clinical trials. Suchtrials can be very expensive -- one NIH study alone is expected to cost over $50 million. But with somany common surgeries being done MIS, an APSA Web site outcomes center would help gather hard dataabout the long-term follow-up that is currently lacking.