A minimally invasive surgical procedure should be defined as one that is safe and is associated with a lowerpostoperative patient morbidity compared with a conventional approach for the same operation. The first procedure, which prevented a previous radical operation, was the use of a cystoscope to look into and treat lesions of the bladder. In 1931, Takagi of Tokyo redesigned the cystoscope and produced an arthroscope 3.5 mm in diameter. Marski Watanable, a pupil of Takagi, tenaciously pursued the development of the arthroscope, and in 1957, based on extensive experience in performing arthroscopy, he published an Atlas of Arthroscopy. Thus, the beginning of minimally invasive surgery. Arthroscopy was quickly accepted by the orthopedic surgeons and in a short time became the preferred method to diagnose and treat maladies of the knee. Since then, minimally invasive surgery has been the focal point of new medical technology. It is within reason to predict that greater than 80% of all surgical procedures will be performed by some form of minimal invasiveness and the majority on an outpatient basis.

Physicians and surgeons who champion minimally invasive surgery are enthusiastic to prove its efficacy and are approaching the challenge vigorously. At the seat of success of minimally invasive surgery is the constant upgrading of surgical instruments, which have gone from crude, cumbersome gadgets to sophisticated, robotically controlled instruments. In observing the rapid and successful implementation of these changes, one can only marvel at the accomplishments that lie ahead. Although improved instrumentation makes the procedure easier and more effective for the surgeon, the surgeon must learn to master the new technology. Thus, the procedure involves a learning curve with its risks. We, as physicians and surgeons, must be certain that the rate of acceptance does not jeopardize patient safety.

Minimally invasive surgical techniques can be mild to radical modifications of conventional surgery. Although one can question the semantic accuracy of the term “minimally invasive surgery,” it does carry connotations of increased safety. The term minimally invasive surgery has gained widespread acceptance, and indeed it should if there is reduction of operative traumatic insult without compromise of therapeutic benefit. Practically every surgical subspecialty is using some form of minimal invasiveness. However, it appears that for some of those techniques to fulfill their greatest potential, one needs to apply a multidisciplinary approach, forming a coherent team of specialists from various disciplines working in cooperation rather than in separate disciplines. I strongly advocate the need for this unified arrangement. Only by such cooperation can we expect to improve the outcome for the patient.

It has also become apparent that advances are the result of the combined influences of technical advances and the skill of the operator. Unfortunately, those performing the procedure need to develop the dexterity and skills for proper execution. In the final analysis, safe and efficient execution depends on the skill of the surgeon or interventionalist. One must always take into consideration the need to convert an endoscopic surgical procedure into an open surgical procedure, and it will always entail the experience and clinical judgement of those involved.