Robert Rege, M.D. Answers Questions On: Minimally Invasive Surgery

Minimally invasive surgery is good, but it’s not always the best. So, even though I’m a proponent of it, there are those who should not have a laparoscopic or robotic procedure. And there are good reasons. I don’t think that minimally invasive surgery is a specialty unto itself. It’s a tool: Do you use the hammer or the saw? Do you use the mini-hammer or the mini-saw?

And here at UT Southwestern Medical Center, the minimally invasive surgery is backed up by the ability to do big surgery if you need to. I think that’s a real advantage of being treated at an academic medical center.

Some people’s concept is that physicians ought to be perfect, and there ought to be no mistakes and nothing that works out badly. The truth is, that’s not medicine. I can’t promise you that if I do your operation, everything will be perfect. In fact, with the informed consent required for all surgeries, I have to tell you that there is an incidence of this and there is an incidence of that. There can be bleeding, and there can be infection. There can be unexpected complications.

What I can promise you is that if I’m your physician, I will do everything I can, if there is a problem, to correct it as efficiently and as quickly as possible. And that I’ll do it. That’s different than, “if it goes badly, I’ll transfer you to another place.” I think what patients get at UTSW is the best care you can get, whatever the circumstances. As an academic medical center, I think that’s what we are: a one-stop shop. 

I think that we’ve already made major advancements in minimally invasive surgery. But there will need to be a major advance in the equipment and tools that we use for that to go any further than it is now. I think that will happen, but I don’t know if it’s next year, five years, 10 years, or longer.

There will probably be some advances in image-guided surgery, in some specialties more than others. It’s already becoming a reality in neurosurgery.

The advances of our colleagues outside surgery, though, continue to change surgery greatly. For example, something that was a complete loss to surgeons, but a good loss because it was a difficult problem, was ulcer surgery. When I was in training there were no medications that were very effective for ulcer disease, and we operated every week, including surgery on people who had ulcers that were not healing. We helped many of them, but some had other problems from the operation. And now, you hardly see ulcer disease because of improved medications. Likewise in cancer. Diagnoses that once were death sentences, or required disfiguring surgeries, now require fewer and less dramatic operations with better outcomes.

I believe that most of the advances are going to be multidisciplinary. There will not only be a place for surgery, but in some situations an increasing role for surgery. The technology is advancing very quickly, for example, in vascular surgery, because many procedures that once required operations are now being done with wire-based, catheter-based, techniques