Delayed assessment and eager adoption of laparoscopic cholecystectomy: Implications for developing surgical technologies

Figure 1 Evolution of technology, laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery. A: A timeline of the percentage of the total number of articles dealing with laparoscopic cholecystectomy’s safety reveals the failure of the literature to satisfactorily answer essential safety issues early in the technology-assessment process; B: An evaluation of the study designs present in the natural orifice transluminal endoscopic surgery (NOTES) literature reveals that the vast majority of studies are technological reports, experimental studies in animal models or simulators, or editorials/commentaries. To date, there have been no clinical studies other than a handful of case reports/series; C: The present literature on NOTES is dedicated primarily to experimental procedures, instrumentation, and theoretical discussion such as advantages/disadvantages or indications/contraindications. Few articles have been devoted to safety or outcome studies, and no articles have compared NOTES procedures to their traditional open or laparoscopic counterparts.