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Invited Critique |

The More Things Change, the More They Stay the Same:  Comment on “Single-Incision Multiport Laparoscopic Cholecystectomy”

Edward H. Livingston, MD
Arch Surg. 2011;146(1):73-74. doi:10.1001/archsurg.2010.288.
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Advances in surgical technique have rarely been enthusiastically received by surgeons. The consequences of surgical complications can be great, resulting in surgeons, as a class, being conservative and resisting change. Such was the case when the first laparoscopic cholecystectomy was reported in 1986 by Eric Mühe,1 a German surgeon who had performed 97 minimally invasive cholecystectomies before Périssat2 and others did their first one. Périssat's group described their approach to laparoscopic surgery a full 2 years after Mühe yet is widely credited with inventing the technique. Mühe never received the appropriate credit for his great achievement because his technique for removing the gallbladder from several small incisions rather than from 1 large incision across the abdomen was uniformly rejected by his colleagues in Germany. A basic surgical tenent was (and remains) that adequate exposure and visualization of the operative field was essential. Wounds heal from side to side and not end to end, we have been taught, and compromising adequate exposure to the operative field by operating through too small an incision placed patients at undue risk for complications resulting from the surgeon's inability to see what he (back then they were all he’s) was doing.

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