surgery once with a mentor wasn’t enough. “In years gone
by, dedicated experts in MIS would fly to different hospitals
to teach in the operating room,” he said. “In modern times,
this has become essentially impossible due to logistical, legal
and regulatory hurdles. As a result, audio-video technology is
being employed to bridge this gap… When incorporated into
the proper educational framework, telementoring can serve
as a powerful tool to support surgeons while they are intro-
ducing new techniques and technologies into their operating
Brunt thinks the more surgeons who are comfortable with
MIS the better, because the use of flexible endoscopy is
starting to be used for therapeutic procedures, in addition to
diagnosing issues. Per oral endoscopic myotomy (POEM) is
one of these examples. Instead of a using an open surgery to
remove blockage between the esophagus and the stomach,
the endoscope probes down the throat and makes an incision
in the esophagus. “There’s basically no skin incision at all.
It’s purely a natural, orifice procedure,” he said.
This is only the start to many possibilities, he estimated. “I
think there’s a lot of interest and potential… in endoscopic
approaches for weight reduction, and we’re going to see a
lot more of that in the next five to seven years,” Brunt said.
“Hopefully, some of those will prove to be effective and low
risk to help patients, because, I think, this is the No. 1 healthcare problem we face in the U.S. today.”
The need for more education also applies to the patient,
Brunt said. Once a surgeon is comfortable performing MIS,
it can benefit the patient in many ways, including less scaring,
a quicker recovery time and less risk of developing a hernia,
To help patients understand their
options, SAGES launched the Get Well
Sooner campaign last year. It’s motivated
by data, like the research found in a 2014
BMJ study (BMJ 2014;349:g4198) of
how MIS is used in the United States. It
found hospitals didn’t consistently offer
MIS as an option to patients, due to fac-
tors such as:
• Location: Rural hospitals offered
the minimally invasive procedure
• Geographic region: The Northeast
had low utilization of MIS
• Perception and attitude to MIS: Some areas as a whole pre-
ferred MIS and some preferred open.
“Important ways to deal with this disparity may be more
standardized postgraduate training, training of surgeons currently in practice, transparency of hospital rates of utilization
of minimally invasive surgery, and better information for
patients,” the study suggested in its conclusion.
The benefits are starting to reach the public’s ears though.
“Gradually, they are searching for not only surgeons with
good reputations, but surgeons who can use the least invasive
techniques and most effective recovery programs to enable
them to safely go through surgery and return to their normal
lives as quickly as possible,” Dunkin predicted. “Everybody
wants a less invasive surgery with quicker return to their nor-
Brunt also said once the option to have a surgery done
with minimal invasion is offered to the patient, that becomes
important to the patient and their families when they see the
benefits. “I think patients are becoming more savvy about
their healthcare options in general. I think some of that is true
around MIS, but I think we can do a better job,” he noted.
He added it’s also a goal to help patients understand their
options and all the surgeries that can be done in a minimally
invasive way, like hernia repair, colon resection, appendecto-
my, gallbladder removal, weight loss surgery and procedures
to help prevent heart burn. For ventral hernia repair alone,
SAGES said there are about 90,000 surgeries performed
each year. Many of these are performed as open surgeries, but
most could be done laparoscopically, Brunt said.
The training options have changed for surgeons pursuing this less invasive approach. Now,
surgeons can participate in a fellowship program. Photo contributed by SAGES.