Invited Commentary Beauty Is in the Eye of the Beholder

摘要

It is hard to overestimate the impact on surgical practice made by the introduction of laparoscopic cholecystectomy 25 years ago. Minimally invasive surgical treatment of many conditions has now become the norm rather than the exception. The ongoing quest to make surgery even less “invasive” has pursued multiple avenues including robotic surgery, the use of Natural Orifices for specimen extraction (minilaparoscopic assisted natural orifice surgery or MANOS), natural orifice transluminal endoscopic surgery (NOTES), and single site laparoendoscopic surgery. It is tempting to assume that each of these avenues would lead to improved patient outcomes when compared to the standard laparoscopic procedures they might supplant. As with so many new techniques and devices, the introduction of single site access surgery led to a flurry of case reports, nicely edited video presentations, uncontrolled case series, and of course a significant marketing push by device makers. Perhaps because of the increased difficulty of performing laparoscopic surgery through a single access site, many of the old guard asked whether or not single site laparoendoscopic surgery truly offered an advantage justifying the need for both additional training and OR time. Much to the credit of Covidien Inc., funding was obtained to perform a well designed study that would definitively answer the questions that so many surgeons were asking. This study reported by Marks and his co-authors is the best study yet done on this topic and provides important Level I evidence that has thus far been lacking in the discussion about single site access surgery. 1 Marks J. Phillips M.S. Tacchino R. et al. Single incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: one year results of a prospective randomized multi-center single blinded trial of traditional multi-port laparoscopic cholecystectomy versus single incision laparoscopic cholecystectomy. J Am Coll Surg. 2013; 216: 1037-1047 Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar Single-Incision Laparoscopic Cholecystectomy Is Associated with Improved Cosmesis Scoring at the Cost of Significantly Higher Hernia Rates: 1-Year Results of a Prospective Randomized, Multicenter, Single-Blinded Trial of Traditional Multiport Laparoscopic Cholecystectomy vs Single-Incision Laparoscopic CholecystectomyJournal of the American College of SurgeonsVol. 216Issue 6PreviewMinimally invasive techniques have become an integral part of general surgery with recent investigation into single-incision laparoscopic cholecystectomy (SILC). This study presents the final 1-year results of a prospective, randomized, multicenter, single-blinded trial of SILC vs multiport cholecystectomy (4PLC). Full-Text PDF