TY - JOUR
T1 - Delayed assessment and eager adoption of laparoscopic cholecystectomy
T2 - Implications for developing surgical technologies
AU - Allori, Alexander C.
AU - Leitman, I. Michael
AU - Heitman, Elizabeth
N1 - Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2010/9/7
Y1 - 2010/9/7
N2 - Despite the prevailing emphasis in the medical literature on establishing evidence, many changes in the practice of surgery have not been achieved using proper evidence-based assessment. This paper examines the adoption of laparoscopic cholecystectomy (LC) into regular use for the treatment of cholecystitis and the process of its acceptance, focusing on the limited role of technology assessment in its appraisal. A review of the published medical literature concerning LC was performed. Approximately 3000 studies of LC have been conducted since 1985, and there have been nearly 8500 publications to date. As LC was adopted enthusiastically into practice, the results of outcome studies generally showed that it compared favorably with the traditional, open cholecystectomy with regard to mortality, complications, and length of hospital stay. However, despite the rapid general agreement on surgical technique, efficacy, and appropriateness, there remained lingering doubts about safety, outcomes, and cost of the procedure that suggested that essential research questions were ignored even as the procedure became standard. Using LC as a case study, there are important lessons to be learned about the need for important guidelines for surgical innovation and the adoption of minimally invasive surgical techniques into current clinical and surgical practice. We highlight one recent example, natural orifice transluminal endoscopic surgery and how necessary it is to properly evaluate this new technology before it is accepted as a safe and effective surgical option
AB - Despite the prevailing emphasis in the medical literature on establishing evidence, many changes in the practice of surgery have not been achieved using proper evidence-based assessment. This paper examines the adoption of laparoscopic cholecystectomy (LC) into regular use for the treatment of cholecystitis and the process of its acceptance, focusing on the limited role of technology assessment in its appraisal. A review of the published medical literature concerning LC was performed. Approximately 3000 studies of LC have been conducted since 1985, and there have been nearly 8500 publications to date. As LC was adopted enthusiastically into practice, the results of outcome studies generally showed that it compared favorably with the traditional, open cholecystectomy with regard to mortality, complications, and length of hospital stay. However, despite the rapid general agreement on surgical technique, efficacy, and appropriateness, there remained lingering doubts about safety, outcomes, and cost of the procedure that suggested that essential research questions were ignored even as the procedure became standard. Using LC as a case study, there are important lessons to be learned about the need for important guidelines for surgical innovation and the adoption of minimally invasive surgical techniques into current clinical and surgical practice. We highlight one recent example, natural orifice transluminal endoscopic surgery and how necessary it is to properly evaluate this new technology before it is accepted as a safe and effective surgical option
KW - Cholecystectomy
KW - Comparative effectiveness research
KW - Endoscopy
KW - Evidence-based medicine
KW - Laparoscopy
KW - Minimally invasive surgery
KW - Natural orifice transluminal endoscopic surgery
KW - Technology assessment
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U2 - 10.3748/wjg.v16.i33.4115
DO - 10.3748/wjg.v16.i33.4115
M3 - Editorial
C2 - 20806426
AN - SCOPUS:77956569207
SN - 1007-9327
VL - 16
SP - 4115
EP - 4122
JO - World Journal of Gastroenterology
JF - World Journal of Gastroenterology
IS - 33
ER -