- Minimal access surgery (MAS)is a term applied to a group of less invasive procedures introduced as replacements for open surgery.
- MAS includes laparoscopic, thoracoscopic, arthroscopic, endoluminal and perivisceral endoscopic techniques.
- The advantages of MAS over open surgery are generally decreased morbidity, less pain, shorter hospital stays, faster recovery and lower costs.
- Some MAS procedures are well established, but new techniques and instrumentation are developing rapidly. Laparoscopic cholecystectomy has diffused rapidly, and a high proportion of general open surgery may eventually be replaced by MAS methods.
- Surgical procedures potentially affected are most pelvic and abdominal operations, including high volume procedures such as appendectomy, hysterectomy and hernirepair. MAS can be expected to:
- reduce overall costs;
- increase operation costs;
- reduce days lost by patients from their normal activities;
- reduce demand for hospital beds;
- possibly increase demand for operating theatres and day care wards.
- Timing and distribution of cost effects of MAS on health care remain uncertain. Factors which will influence costs include shorter hospital stay, operating times, levels of reimbursement, costs of equipment, effects on infrastructure, the extent of clinical advantage over older methods, the extent of replacement of open procedures, patient expectations, long-term morbidity, mortality and variations in outcome at different centres.
- If benefits from the use of MAS techniques are to be maximised it will be essential to resolve issues related to:
- provision of adequate training for surgeons, theatre staff and technicians;
- assessment of costs and effectiveness of each MAS procedure prior to wide diffusion, and subsequent monitoring of use and outcomes;
- agreement on appropriate indications, including out-patient use;
- the relative merits of disposable and reusable instruments.
The following suggestions are intended to aid the deliberate, cost effective introduction of further MAS techniques:
- A forum for dialogue on this area of technology between government agencies, professional bodies, hospitals and manufacturing industry should be put in place. Such a forum could provide an opportunity to maintain oversight of MAS techniques and develop strategies to promote their appropriate introduction, use and support;
- Professional bodies should continue to take responsibility for promoting appropriate training programs for surgical and other staff involved with MAS. The initiative taken by the Royal Australasian College of Surgeons in regard to laparoscopic cholecystectomy provides a useful example of such an approach;
- Adequate assessment of the safety,'costs and effectiveness of MAS methods should be regarded as an integral component in the introduction of these technologies into the health care system;
- Close attention should be given to obtaining measures of the relative effectiveness of different types of instrumentation.
It is also suggested that there may be opportunities for Australian industry in the development of new instrumentation for MAS techniques.