Don’t try to be minimally invasive, and beware of going astray!

In recent years, with the extensive development of minimally invasive surgery, mainly endoscopic surgery and lumpectomy in China, the recognition of patients has gradually increased, as if the traditional open surgery has become obsolete, and only minimally invasive surgery is the best. However, do not go into the wrong zone, not only do not achieve the purpose of minimally invasive surgery, but also cause greater trauma to the body, “minimally invasive” into “huge”. Abdominal surgery, for example, minimally invasive surgery is mainly laparoscopic surgery, simply put is to send a camera into the abdominal cavity, the doctor through the viewing of television images of the organs in the abdominal cavity, the use of instruments sent into the abdominal cavity to carry out the operation, the surgeon’s hands generally do not enter the abdominal cavity. Because the surgery is not performed under direct vision, strict training is required for the surgeon, and beginners are required to perform the surgery under the guidance of an experienced senior surgeon. Laparoscopic cholecystectomy was first performed, and it is the most mature surgical procedure. It became popularized in the country around 1990 and is now performed in many county hospitals. With the advancement of technology, laparoscopic gastrectomy, intestinal resection, hepatectomy, splenectomy, etc., almost all surgeries can be done laparoscopically, but not all patients are suitable for this procedure. Taking the most mature laparoscopic cholecystectomy as an example, this procedure is currently known as the “gold standard” of cholecystectomy. In general, about 5% of laparoscopic surgeries cannot be completed and need to be converted to open surgery, and in the acute inflammatory phase, more than 20% of cases need to be converted to open surgery. In addition, there is an increase in complications, especially of bile duct injuries, compared to open surgery. Some patients are more traumatized by laparoscopic surgery that damages the bile ducts and then open surgery to repair them. However, if the surgery can be successfully completed, it has obvious advantages. The patient recovers very quickly and can be discharged from the hospital in 1 to 2 days, with very little pain, and can get out of bed and eat the next day. And the adhesions in the abdominal cavity after the surgery are also very mild. Another example is laparoscopic surgery for malignant tumors, because the incision is small and the operation has some limitations, for the thoroughness of tumor resection is controversial both at home and abroad. Some surgeons think that malignant tumors are not suitable for laparoscopic surgery because of incomplete radicality and relatively high metastatic rate; however, some surgeons think that there is no difference in the effect of the two compared with open surgery. Therefore, in foreign hospitals, doctors usually explain to patients and their families that laparoscopic surgery has been carried out for a relatively short period of time, the long-term effects are still uncertain, and it is up to the patients and their families to decide which surgical procedure to choose. Therefore, minimally invasive surgery is only a means of treatment, and has its own advantages over traditional surgery, mainly in terms of reduced post-operative pain, faster recovery, and reduced body surface surgical scarring. But compared with traditional surgery, there is not much difference in the long-term results.