Minimally invasive surgery (MIS) or Minimal Access Surgery or Laproscopic Surgery or Laparoscopic Surgery has come a long way from the time when it was first performed on a human subject in 1910 by Hans Christian Jacobaeus of Sweden. It was only in 1950 that first Diagnostic Laparoscopy was reported by Raoul Palmer. The technology has improved along with the techniques and skills of surgeons. With the improvement in anesthetics and better vision systems for laproscopy, the surgeons started using MIS for more complicated surgeries. In the 70’s the first series on Salpingectomy was reported from Brazil. MIS remained in the domain of gynecologists for next 20 years. It was only in 1990’s that Laparoscopic surgery was accepted by General Surgeons and was used more extensively for general surgical procedures such as cholecystectomy and appendectomy. Today MIS is the gold standard for cholecystectomy for all the benefits it provides.
The goal of laparoscopic or minimally invasive cancer surgery (with or without robotic assistance) is to reproduce the oncologic results of an open procedure, while decreasing the surgical complications and postoperative recovery time. MIS is taking its baby steps into cancer care. More evidence is emerging day by day about the safety and standardisation of laparoscopy in cancer surgery. The advantages and disadvantages of Minimal Access Cancer Surgery (MACS) remains the same as other general surgical procedures.
It is important to bear in mind that Minimal Access Cancer Surgery is a treatment modality, and not a treatment by itself. It does not change the surgery itself, but only changes the way it is performed. Therefore, the preference to use laparoscopic surgery can be evaluated in terms of its effectiveness, patient recovery and ease of surgical performance.
What is more important in treating cancer patients is that long-term survival must not be compromised in exchange for improvements of short-term morbidity. The margin of error for inadequate surgery is extremely narrow and the price to pay is the patient developing recurrent or metastatic cancer that is usually fatal. As such all surgeons offering this surgical approach must first be competent in the open-approach and need to audit the surgical adequacy, cancer recurrence rate and survival outcomes from time to time.