Minimally invasive surgery and technology

Minimally Invasive Surgery (MIS) aims to reduce the morbidity of surgery-mainly by reducing the injury of surgical access. Politicians hope MIS will square the circle of spiralling health costs while defence technology suppliers see it as an outlet that might soften the blow of peace. Technology needs exist in many directions, including image display, body cavity access, spatial perception, instrumentation for tissue cutting, approximation and extraction, miniaturisation, automation and physiological control. Solving some problems (e.g. Miniaturisation of endoscopes) may render other needs (e.g. stapling) obsolete before they are fully met. In the long term advances in molecular biology will render obsolete procedures that are now at the cutting edge of MIS. Sober appraisal of current technology needs in this light can enable planning of future devices-particularly with regard to development investment and capital cost of acquisition. Cost is a central issue: The current UK health care budget is of the order of £700 p.a., but operating time costs £12 per minute, even at the current level of technical sophistication. New devices must therefore enable shorter better operations and be more convenient to use than not to use. Capital equipment must be cheap enough to be amortised during its obsolescence life. Many available technologies, especially those derived from defence, are not practically useful