Laparoscopic surgery - gastroenterologists' referrals and expectations

Advancements of endoscopic interventions have enabled non-surgeon endoscopists to stray into domains traditionally maintained by surgeons. On the other hand, surgery has increasingly made use of endoscopic tools to access surgical sites of interest. Minimally invasive surgeons now command endoscopic technique to safely control the sophisticated equipment involved. A successful cooperation between the referring gastroenterologist and his minimally-invasive surgeon partner is therefore characterized by reciprocal respect, exchange, and mutual learning. The referring gastroenterologist should be interested and entitled to know, which surgical approach will be planned in every specific patient referred. Also, both sides will have to be candid about their results: A procedure can work fine in one place while in other institutions, patients may fare worse for a variety of reasons. This underlines the importance of quality control and, where established, certification. Confidence and trust both will grow when both sides help each other out in difficult situations with their armamentarium, e.g., by endoluminal vacuum therapy or by minimally invasive closure of post-interventional wall defects. Last but not least, gastroenterologists might appreciate being involved in the actual procedure. Not only may they assist in finding the site of resection (e.g., illuminating a gastric submucosal mass during laparoscopic surgery), but they may participate in or completely deliver certain parts of the intervention, both supporting the surgeon and enhancing their own proficiency. In some patients and situations it may be prudent to execute a conventional surgical approach rather than performing minimally invasive surgery. The presentation will discuss a gastroenterologist's opinions, concerns, and areas of interest in defining a successful cooperation with the minimally invasive surgeon.