The 0.9% Solution?:  Comment on “Maneuvers to Decrease Laparoscopy-Induced Shoulder and Upper Abdominal Pain”

Laparoscopic surgery, once the cutting edge of gastrointestinal tract and general surgery, is now routine and the search is on for the next breakthrough in minimally invasive surgery. Be it natural orifice transluminal endoscopic surgery or single-site surgery, the holy grail is reducing pain and speeding recovery. Whether these new techniques can live up to expectations is an open question. Furthermore, the current health care environment's pressures to reduce cost combined with sociopolitical forces such as overly restrictive conflict-of-interest policies have put a chill on device development. Improved cosmesis alone is unlikely to justify adoption of new procedures. Payers are demanding evidence-based justification for coverage of new procedures. Given this climate, it is clear that a critical element for advancing surgical care is the value equation. Value is defined as quality divided by cost. Clearly we will have to do more with less or do better with what we already have if we are to meet this challenge.