Commentary to “‘Open’ minimally invasive surgery in pediatric urology”: Ought we not...
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Commentary to ‘‘‘Open’ minimally invasive surgery in pediatric urology’’ Ought we not (re)define minimally invasive surgery? Luke Harper* Paediatric Surgery, CHR F Guyon, Bellepierre, 97405 Saint-Denis, Reunion, France Received 28 August 2009; accepted 1 September 2009 Available online 12 October 2009 Dear Editor, I read with interest the article entitled ‘Open’ minimally invasive surgery in pediatric urology. The authors report and discuss their experience with, what they call, open minimally invasive surgery (MIS). Open MIS is defined as a surgical technique which uses small incisions and obviates the use of laparoscopic instruments. It is true that the term ‘minimally invasive surgery’ was, by tradition, understood to refer to laparoscopic or endo- scopic surgery. This was probably already a lexical shortcut since, though the incisions might individually be smaller, the surgery itself is often not less invasive. The problem with new terms such as ‘open minimally invasive surgery’ is that these appellations are purely arbitrary, they relate solely to incision size, and in some cases the surgery itself seems more invasive than classic surgery. In this report, the authors refer to open MIS for renal surgery performed through small incisions (ranging from 1.3 to 2.5 cm in patients <1 year of age, and 2.4 to 5.4 cm in patients >10 years of age). What is the definition of small? Is it defined just as smaller than we used to perform? Or smaller than other surgeons do? Most of us try to use small incisions, but when do they become minimally invasive? The article also refers to a mini-Pfannenstiel incision. What defines a mini-Pfannenstiel incision compared to a Pfannenstiel incision? The question is, if we want to know what we are talking about, should we define exactly when open surgery becomes minimally invasive, through standard incision sizes related to child weight, for example? Furthermore, the report mentions performing orchi- opexy through a circumcision incision after complete degloving of the penis. I am surprised that this can be called minimally invasive compared to a circumcision and scrotal incision. Full penile degloving seems rather aggressive and not without risk, nor potential postoperative discomfort, whilst the cosmesis of scrotal incisions is close to irrele- vant. I honestly question whether this kind of alternative technique should be coined minimally invasive compared to classic techniques. Finally, the least invasive surgery remains no surgery at all. Nowadays there are very few indications for performing any kind of surgery for multi- cystic dysplastic kidneys or low-grade VUR for example, and not all reports on ‘minimally invasive techniques’ clearly address the question of indications. Finally, I believe we should clearly (re)define what ‘minimally invasive’ means, in order to give the term any degree of scientific value. DOI of original article: 10.1016/j.jpurol.2009.02.195. * Tel.: þ262 262 906494; fax: þ262 262 905498. E-mail address: [email protected] 1477-5131/$36 ª 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2009.09.007 Journal of Pediatric Urology (2010) 6, 95
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Transcript of Commentary to “‘Open’ minimally invasive surgery in pediatric urology”: Ought we not...
Journal of Pediatric Urology (2010) 6, 95
Commentary to ‘‘‘Open’ minimally invasive surgeryin pediatric urology’’Ought we not (re)define minimally invasive surgery?
Luke Harper*
Paediatric Surgery, CHR F Guyon, Bellepierre, 97405 Saint-Denis, Reunion, France
Received 28 August 2009; accepted 1 September 2009Available online 12 October 2009
Dear Editor,
I read with interest the article entitled ‘Open’ minimallyinvasive surgery in pediatric urology. The authors reportand discuss their experience with, what they call, openminimally invasive surgery (MIS). Open MIS is defined asa surgical technique which uses small incisions and obviatesthe use of laparoscopic instruments.
It is true that the term ‘minimally invasive surgery’ was,by tradition, understood to refer to laparoscopic or endo-scopic surgery. This was probably already a lexical shortcutsince, though the incisions might individually be smaller,the surgery itself is often not less invasive. The problemwith new terms such as ‘open minimally invasive surgery’ isthat these appellations are purely arbitrary, they relatesolely to incision size, and in some cases the surgery itselfseems more invasive than classic surgery.
In this report, the authors refer to open MIS for renalsurgery performed through small incisions (ranging from1.3 to 2.5 cm in patients <1 year of age, and 2.4 to 5.4 cmin patients >10 years of age). What is the definition ofsmall? Is it defined just as smaller than we used to perform?Or smaller than other surgeons do? Most of us try to usesmall incisions, but when do they become minimally
DOI of original article: 10.1016/j.jpurol.2009.02.195.* Tel.: þ262 262 906494; fax: þ262 262 905498.
E-mail address: [email protected]
1477-5131/$36 ª 2009 Journal of Pediatric Urology Company. Publishedoi:10.1016/j.jpurol.2009.09.007
invasive? The article also refers to a mini-Pfannenstielincision. What defines a mini-Pfannenstiel incisioncompared to a Pfannenstiel incision? The question is, if wewant to know what we are talking about, should we defineexactly when open surgery becomes minimally invasive,through standard incision sizes related to child weight, forexample?
Furthermore, the report mentions performing orchi-opexy through a circumcision incision after completedegloving of the penis. I am surprised that this can be calledminimally invasive compared to a circumcision and scrotalincision. Full penile degloving seems rather aggressive andnot without risk, nor potential postoperative discomfort,whilst the cosmesis of scrotal incisions is close to irrele-vant. I honestly question whether this kind of alternativetechnique should be coined minimally invasive compared toclassic techniques. Finally, the least invasive surgeryremains no surgery at all. Nowadays there are very fewindications for performing any kind of surgery for multi-cystic dysplastic kidneys or low-grade VUR for example, andnot all reports on ‘minimally invasive techniques’ clearlyaddress the question of indications.
Finally, I believe we should clearly (re)define what‘minimally invasive’ means, in order to give the term anydegree of scientific value.
d by Elsevier Ltd. All rights reserved.
