Department of Surgery and Cancer, London, UK.
Br J Surg. 2015 Jan;102(2):e151-7. doi: 10.1002/bjs.9706.
In the past 30 years surgical practice has changed considerably owing to the advent of minimally invasive surgery (MIS). This paper investigates the changing surgical landscape chronologically and quantitatively, examining the technologies that have played, and are forecast to play, the largest part in this shift in surgical practice.
Electronic patent and publication databases were searched over the interval 1980-2011 for ('minimally invasive' OR laparoscopic OR laparoscopy OR 'minimal access' OR 'key hole') AND (surgery OR surgical OR surgeon). The resulting patent codes were allocated into technology clusters. Technology clusters referred to repeatedly in the contemporary surgical literature were also included in the analysis. Growth curves of patents and publications for the resulting technology clusters were then plotted.
The initial search revealed 27,920 patents and 95,420 publications meeting the search criteria. The clusters meeting the criteria for in-depth analysis were: instruments, image guidance, surgical robotics, sutures, single-incision laparoscopic surgery (SILS) and natural-orifice transluminal endoscopic surgery (NOTES). Three patterns of growth were observed among these technology clusters: an S-shape (instruments and sutures), a gradual exponential rise (surgical robotics and image guidance), and a rapid contemporaneous exponential rise (NOTES and SILS).
Technological innovation in MIS has been largely stagnant since its initial inception nearly 30 years ago, with few novel technologies emerging. The present study adds objective data to the previous claims that SILS, a surgical technique currently adopted by very few, represents an important part of the future of MIS.
在过去的 30 年中，由于微创手术（MIS）的出现，外科手术实践发生了巨大变化。本文按时间顺序和定量分析了不断变化的手术领域，研究了在这种手术实践转变中发挥最大作用并预计将继续发挥最大作用的技术。
在 1980 年至 2011 年期间，通过电子专利和出版物数据库搜索了（“微创”或腹腔镜或腹腔镜检查或“最小进入”或“钥匙孔”）和（手术或外科或外科医生）。将得到的专利代码分配到技术群中。在当代外科文献中反复提到的技术群也包括在分析中。然后绘制了由此产生的技术群的专利和出版物的增长曲线。
最初的搜索显示，符合搜索标准的专利有 27920 项，出版物有 95420 项。符合深入分析标准的集群为：仪器，图像引导，手术机器人，缝合线，单切口腹腔镜手术（SILS）和自然腔道内镜手术（NOTES）。在这些技术群中观察到三种增长模式：S 形（仪器和缝线），逐渐的指数增长（手术机器人和图像引导）以及快速的同期指数增长（NOTES 和 SILS）。
自近 30 年前微创手术最初出现以来，微创技术的创新在很大程度上已经停滞不前，很少出现新的技术。本研究为之前的说法增加了客观数据，即 SILS 是一种目前很少采用的手术技术，代表了 MIS 的未来的重要组成部分。
