Reality Check for SILS and Notes: Using Publications to Provide Perspective On New Procedures

Tiffany Stoddard, MD, Igor Milosevic, MD, Stephen Kavic, MD. University of Maryland Medical Center

Introduction
It has always been difficult to determine the true worth and utility of a new procedure. However, with the recent explosion in communication and social media, it may not be possible to assess a procedure objectively. Both single incision laparoscopic surgery (SILS) and natural orifice transgastric endoscopic surgery (NOTES) have attracted substantial headlines, but their relative merit remains controversial. Our goal was to attempt to use the totality of the surgical literature as a guide to the current status of these procedures.

Methods
We performed a MEDLINE search for total number of references for SILS, stratified by year of publication. We then performed a similar search for NOTES, as a slightly more mature procedure that has remained outside the surgical mainstream. As a model of success, we repeated the search for the model of laparoscopic cholecystectomy (LC). All three procedures were then tabulated from year of first publication for comparison.

Results
During our search we found the traditional LC remains a popular topic of discussion with roughly 400-600 publications per year. In contrast the peak number of publications referencing SILS was 88, similar to NOTES at 74. Further, the slope of the curve suggests that the popularity of SILS parallels NOTES moreso than LC.

Discussion
Although SILS and NOTES may garner headlines, the volume of surgical literature may be an early guide to the ultimate fate of these procedures. To date, the dissemination of SILS is much more comparable to NOTES than to the initial phase of LC. We conclude that the volume of surgical literature may be an accurate indicator of the actual use and role of newer procedures such as SILS.
 

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