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MIS at the Millennium
HPB 1999Volume I , Number 3, I 11 - 112
Editorial MIS at the Millennium
It has been said that the three great medical advances of the last century are antisepsis, anaesthesia and organ transp lantation. But I think it would be fair to say that the introduction of endosurgery and minimally invasive surgery (MIS) need to be added to this list, particularly as we go forward into the next millennium. Starting even before the work of Ott, Jacobeus and Kelling at the turn of the century, the concept of exploring and eventually
treat a host of malignant conditions. T he fe aS ibil ity of operating in the open magnet has already been demonstrated, and its util ity will continue to expand in the future as new instruments and techniques are developed. Our ability to visualize structures is central to our ability to understand and treat them, and this means that computerenhanced imaging such as virtual endoscopy will provide important advances in our understanding of patho-
operating on the body through either a n atural orifice or a minute incision must stand next to the trinity of advances mentioned above in importance. The importance of this development increases when you consider that the discipline of endosurgery covers a broad array of specialties and brings into the same clinic surgeons, internists and interventionalists. Eventually, they all work together under the same tent. The management of HPB diseases which today we take for granted would be inconceivable were it not for endosurgery and minimally invasive surgery. It goes without say ing that endosurgery prov ided insight into diagnostic dilemmas of the pancreatic and biliary system that routine radiology could not untangle. The original introduction of minimally invasive surgery focused on the biliary tree but has long since expanded to include a variety of other organ systems. Nevertheless, the lessons learned in this arena have provided extensive insight into the management of other disease entities. Where will endosurgery and MIS go in the new millennium ? It is fair to say that there wi ll be even greater emphas is on collaborative ventures that bring together image-guided therapy under the auspices of interventional radiologists, endoscopists and surgeons, all focused on the diagnosis and management of a host of diseases. The HPB system will certainly be at the forefront of this revolution. Image-guided energy delivery systems for the management of hepatic lesions will perhaps be the first test of our imagination in the 21 st century. Both high-intensity focused ultrasound and radio-frequency will provide avenues to
physiology. Likewise, other diagn ostic tools such as endoscopic ultrasound and spectroscopy offer important advances into diagnosing HPB disease. Where will the next big advances in minimally invasive surgery be found ? The opportunities are various, but it seems ev ident that robotics and telemedicine are certain to have an important impact on surgery, just as laparoscopy has so profoundly affected it during the last decade. One imagines robotically controlled surgical instruments, guided by MR or CT images and used to operate on previously inaccess ible structures. Moreover, exciting n ew technologies such as photodynamic therapy (PDT ) will allow both surgeon and internist to extend the arena of care. Jointly, these initiatives will undoubtedly contribute to better and less invas ive care. Finally, there is no question that gene therapy is coming. How will it be applied to HPB diseases? What will the delivery system be? It will surely fall into the minimally invasive arena. In addition to the technical advances that will bear fruit (n the beginning of the new mi llennium, accountability, in the form of outcome studies and technology assessment, will have a major impact on the delivery of health care to all nations, not just the industrialized world. Providing adequate care at low cost is a challenge that far exceeds the technical challenges we have already mastered or are in the process of mastering. It is exciting to think that our society will be at the forefront of these changes, just as it h as been for the last three decades. The socioeconomic climate demands dramatic rethinking of the way health care is delivered.
© 1999 Isis Medical Media Ltd.
II I
DC i3moks T hus, the new millennium brings challenges and opportunities. I have no doubt that we as physicians, particularly physicians arrayed across such a broad background, are up to the challenges that await us. Advanced tech n ology, multi-disciplinary care, outcome assessment and
112
adequate parking are the major conundrums we face; all but the latter are soluble!
DC Brooks, MD Boston, USA
Editorial MIS at the Millennium
It has been said that the three great medical advances of the last century are antisepsis, anaesthesia and organ transp lantation. But I think it would be fair to say that the introduction of endosurgery and minimally invasive surgery (MIS) need to be added to this list, particularly as we go forward into the next millennium. Starting even before the work of Ott, Jacobeus and Kelling at the turn of the century, the concept of exploring and eventually
treat a host of malignant conditions. T he fe aS ibil ity of operating in the open magnet has already been demonstrated, and its util ity will continue to expand in the future as new instruments and techniques are developed. Our ability to visualize structures is central to our ability to understand and treat them, and this means that computerenhanced imaging such as virtual endoscopy will provide important advances in our understanding of patho-
operating on the body through either a n atural orifice or a minute incision must stand next to the trinity of advances mentioned above in importance. The importance of this development increases when you consider that the discipline of endosurgery covers a broad array of specialties and brings into the same clinic surgeons, internists and interventionalists. Eventually, they all work together under the same tent. The management of HPB diseases which today we take for granted would be inconceivable were it not for endosurgery and minimally invasive surgery. It goes without say ing that endosurgery prov ided insight into diagnostic dilemmas of the pancreatic and biliary system that routine radiology could not untangle. The original introduction of minimally invasive surgery focused on the biliary tree but has long since expanded to include a variety of other organ systems. Nevertheless, the lessons learned in this arena have provided extensive insight into the management of other disease entities. Where will endosurgery and MIS go in the new millennium ? It is fair to say that there wi ll be even greater emphas is on collaborative ventures that bring together image-guided therapy under the auspices of interventional radiologists, endoscopists and surgeons, all focused on the diagnosis and management of a host of diseases. The HPB system will certainly be at the forefront of this revolution. Image-guided energy delivery systems for the management of hepatic lesions will perhaps be the first test of our imagination in the 21 st century. Both high-intensity focused ultrasound and radio-frequency will provide avenues to
physiology. Likewise, other diagn ostic tools such as endoscopic ultrasound and spectroscopy offer important advances into diagnosing HPB disease. Where will the next big advances in minimally invasive surgery be found ? The opportunities are various, but it seems ev ident that robotics and telemedicine are certain to have an important impact on surgery, just as laparoscopy has so profoundly affected it during the last decade. One imagines robotically controlled surgical instruments, guided by MR or CT images and used to operate on previously inaccess ible structures. Moreover, exciting n ew technologies such as photodynamic therapy (PDT ) will allow both surgeon and internist to extend the arena of care. Jointly, these initiatives will undoubtedly contribute to better and less invas ive care. Finally, there is no question that gene therapy is coming. How will it be applied to HPB diseases? What will the delivery system be? It will surely fall into the minimally invasive arena. In addition to the technical advances that will bear fruit (n the beginning of the new mi llennium, accountability, in the form of outcome studies and technology assessment, will have a major impact on the delivery of health care to all nations, not just the industrialized world. Providing adequate care at low cost is a challenge that far exceeds the technical challenges we have already mastered or are in the process of mastering. It is exciting to think that our society will be at the forefront of these changes, just as it h as been for the last three decades. The socioeconomic climate demands dramatic rethinking of the way health care is delivered.
© 1999 Isis Medical Media Ltd.
II I
DC i3moks T hus, the new millennium brings challenges and opportunities. I have no doubt that we as physicians, particularly physicians arrayed across such a broad background, are up to the challenges that await us. Advanced tech n ology, multi-disciplinary care, outcome assessment and
112
adequate parking are the major conundrums we face; all but the latter are soluble!
DC Brooks, MD Boston, USA