Minimal access surgery

The development of minimal access surgery (MAS) is one of the most important elements in the evolution of surgery in recent history. This unprecedented step in surgical technology has challenged our ability to teach the requisite cognitive and psychomotor skills. This chapter will deal with aspects related to the required upskilling. 

A nnmber of drainage techniqnes have been described nsing endoscopy and laparoscopy. These minimal-access techniques may offer advantages when compared with traditional surgery but probably wiU be used less often than radiologically assisted percutaneous drainage techniques. 

One of the application segments that is commonly associated with polymer blends is that of surgical instruments. As surgical techniques have proliferated, so has the need for increasingly specialized instruments. The drive toward minimally invasive surgeries has created the need for miniaturization, which in turn drives the need for smaller components with sufficient strength and durability. Access devices that are appropriate for polymer blends include trocars, retractors, and speculums. Hand instruments include staplers and forceps. Thermal ablation and electrosurgi-cal techniques require powered instruments. 

The introduction of minimally invasive thermal ablation techniques offers a safe and accurate alternative to open or laparoscopic surgery in the treatment of renal tumors. Experimental as well as clinical studies proved RF ablation to be a safe and effective treatment option for small RCCs. It is well tolerated in patients with percutaneously accessible lesions. However, the long-term outcome remains to be determined. Until then its use is limited to selected patients. Despite these limitations, published experience with renal RF ablation is continuously growing. As soon as its long-term effectiveness is proven, this technique holds the potential to replace surgery as first-line therapy in small RCCs. 

---