On my second day at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) annual meeting, the highlight of the day was definitely the Presidential Debates session. Having just written MRG's US Markets for Laparoscopic Devices 2013 report in December, I was quite interested to listen to one debate in particular: ?Be it Resolved That It Is Time to Play ?Taps? for Single Incision Laparoscopy.? Or, in other words, it's time to give up on single-site surgery. When the session chair took a quick survey of the audience, most were undecided, with a handful raising their hands for ?Pro? and some raising their hands for ?Con?. So, it looked like this debate would have considerable room to sway some of the surgeons in the room.
Dr. Steven Schwaitzberg, who argued for the ?Pro? side, used a series of Star Wars metaphors (with pictures to match) to warm up the audience, joking about how he is a lone Jedi working against the Dark Force's plan to turn every surgery into a single-site surgery. He ended his argument with a study showing that single-site surgery leads to longer surgery times, more blood loss, and more complications. Although his presentation was charismatic and very entertaining, I did find it to be light on clinical data?after all, he only showed the results of one study. The available clinical literature on the subject suggests that the benefits and risks of single-site surgery do differ somewhat for different types of procedures.
Dr. Jeffrey L. Ponsky argued in favor of single-incision laparoscopy, basing his argument on the idea that it is a surgeon's responsibility to continue to innovate and move towards less invasive options for patients. He drew parallels between single-site surgery and laparoscopy, arguing that when laparoscopy was first invented, most surgeons laughed at the individuals who championed the technique, saying that it just made surgery more difficult and didn?t offer any benefits to patients aside from smaller scars?a familiar criticism from those who argue against single-site surgery today.
Dr. Ponsky's argument, however, was even lighter on clinical data, which seemed to sway the audience more towards Dr. Schwaitzberg's side. Although things may have gone south for single-incision laparoscopy in this particular debate, I think it is quite telling that most of the surgeons in the audience were undecided at the beginning. It looks like the majority of surgeons are still waiting to decide whether single-site surgery will become a part of routine practice in the future. On that same note, I also noticed that there were many conference posters on the exhibition floor dedicated to exploring the use of single-incision laparoscopy across different procedures, particularly in colorectal procedures. Overall, it looks like the fate of single-site surgery is still undecided?only time will tell.