A new stage of surgical treatment: super minimally invasive surgery

摘要

Introduction The application of video-assisted thoracoscopy, laparoscopy, and Da Vinci robotic surgery allows surgical treatment to enter the stage of minimally invasive surgery (MIS).[1–3] Compared with traditional open surgery, MIS is less invasive with a shorter hospital stay.[4,5] However, both MIS and traditional open surgery fail to maintain the integrity of organs while resecting the lesions. To date, MIS does not change the treatment mode used in traditional open surgery, namely, “resect not only lesions but also partial or complete selected organ,” leading to loss of some organs and anatomical reconstruction of remaining organs. Every organ in the human body has its own function and plays an important role in the normal metabolism of our body; thus, no organ is redundant. Moreover, we know much less about the interaction between organs than the function of special organs. If one organ was partially or completely resected, the remaining organ might not function as well as it did before the resection. The functions of other organs might be affected by the loss or partial removal of this organ. Patients often suffer from complications related to the loss of organs. For example, patients who underwent proximal gastrectomy often suffered from reflux post-operation, resulting in a decline in their sleep quality. Patients often lived with dyspepsia, innutrition, diarrhea, and anemia after total gastrectomy. Human organ reconstruction that accomplishes the creation of organs that are the same as those we are born with remains far from possible. The highest expectation of the disease treatment method is to remove lesions and retain organs without inducing additional discomfort. It is better not to break the normal structure or affect survival. With the development of endoscopy, it has become possible to treat more lesions by endoscopy without changing the anatomical structure of our body. Considering that more and more lesions might be diagnosed in their early stage with the development of medicine, a new treatment method, namely, super minimally invasive surgery (SMIS) was initially reported by Linghu in 2016.[6] SMIS is believed to achieve a therapeutic effect similar to that of surgical treatment without damaging organ structure and function. Definition SMIS is defined as “curing the disease while preserving the integrity of human organ anatomy.” The purpose of SMIS is to cure diseases without damaging organ structure and function, together with ensuring a normal survival time and post-operative quality of life (QoL). The treatment modes of traditional open surgery, MIS, and SMIS are shown in Supplementary Figure 1, https://links.lww.com/CM9/A585. Surgical treatments, such as endoscopic mucosal resection, endoscopic submucosal dissection (ESD), and endoscopic submucosal tunnel dissection, could be regarded as SMIS because they can be applied to resect early gastrointestinal cancer without injuring the integrity of the gastrointestinal duct. Not all endoscopic operations are classified as SMIS, whereas laparoscopy and thoracoscopy are classified as MIS. Some operations under laparoscopy and thoracoscopy did not affect the anatomical structure of organs and should also be regarded as SMIS, such as video-assisted thoracoscopic enucleation, which only resected lesions. Surgical operations, no matter whether endoscopy or video-assisted thoracoscopy, should be regarded as SMIS if they did not affect the anatomical structure of organs while curing disease. Comparison Between SMIS and MIS To better understand the difference between SMIS and MIS, we compared the use of these methods in the treatment of the same type of disease. Anastomositis and gastric retention could occur after traditional open surgery [Supplementary Figure 2A–C, https://links.lww.com/CM9/A586] and MIS [Supplementary Figure 2D and 2E, https://links.lww.com/CM9/A586] for the treatment of early gastric cancer that, consequent to partial loss of stomach, has necessi