metricas
covid
Buscar en
Cirugía Española
Toda la web
Inicio Cirugía Española Cirugía endoscópica y medicina basada en la evidencia
Información de la revista
Vol. 70. Núm. 4.
Páginas 209-214 (octubre 2001)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 70. Núm. 4.
Páginas 209-214 (octubre 2001)
Acceso a texto completo
Cirugía endoscópica y medicina basada en la evidencia
Endoscopic surgery and evidence-based medicine
Visitas
6545
E.M. Targarona
,1
Autor para correspondencia
etargarona@hsp.santpau.es

Correspondencia: Dr. E.M. Targarona. Servicio de Cirugía. Hospital de Sant Pau. P. Claret, 167. 08025 Barcelona.
, E.M. Neugebauer**, M. García-Caballero***, M. Trias*
* Servicio de Cirugía General y del Aparato Digestivo. Hospital de la Santa Cruz y San Pablo. Universidad Autónoma de Barcelona. Barcelona.
** Biochemische und Experimentelle Abteilung. II. Chirurgischer Lehrstuhl. Universidad de Colonia. Colonia. Alemania.
*** Departamento de Cirugía. Universidad de Málaga. Málaga.
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Resumen
Introducción

La cirugía endoscópica (CE) ha sido considerada la revolución incontrolada más importante en cirugía en los últimos años. Sin embargo, existe la impresión de que pocos de estos nuevos procedimientos han sido evaluados mediante estudios controlados randomizados (ECR).

Objetivo

Analizar el grado de evaluación de la CE en la base de datos PubMed, Agencias de evaluación tecnológica y Cochrane Library.

Resultados

De un total de 18.814 documentos encontrados, únicamente el 4,2% (788) corresponden a ECR y, de ellos, 143 comparaban procedimientos laparoscópicos con cirugía abierta. Únicamente 7 procedimientos endoscópicos de los 33 más aceptados han sido analizados de forma aleatoria. Tampoco se encontraron estudios en las agencias con interés en medicina basada en la evidencia (MBE).

Conclusión

Los ECR no se han utilizado ampliamente en el análisis de la CE. Las razones son múltiples y se relacionan con una falta de cultura de MBE entre los cirujanos y dificultades técnicas para efectuar este tipo de estudios tanto por parte de los cirujanos como de los pacientes. La implantación de la MBE requiere el impulso individual y la concienciación de sus ventajas a medio y largo plazo, tanto de las asociaciones profesionales como de las autoridades sanitarias.

Palabras clave:
Cirugía endoscópica
Medicina basada en la evidencia
Estudios controlados
Introduction

Endoscopic surgery is considered the most significant surgical revolution to have taken place in the last few years. However, few of these new techniques have been evaluated through randomized controlled trials.

Objective

To analyze the extent to which endoscopic surgery has been evaluated through randomized controlled trials and the factors impeding its diffusion.

Material and methods

Publications on endoscopic surgery were retrieved from PubMed, Health Technology Assessment Agencies and the Cochrane Library. Results. Of 18,814 documents retrieved, only 4.2% (788) were randomized controlled trials; of these, 143 compared laparoscopic procedures with open surgery. Only 7 of the 33 most widely accepted endoscopic procedures were the subject of randomized analysis. No studies were found in agencies interested in evidence-based medicine.

Conclusions

Randomized controlled trials are not widely used in the evaluation of endoscopic surgery. The reasons for this are multiple and are related to the lack of evidence-based culture among surgeons and the technical difficulties, for both surgeons and patients, of carrying out this type of study. The implantation of evidence-based medicine requires individual effort and greater awareness of its mediumand long-term advantages among professional associations and health authorities.

Key words:
Evidence-Based Medicine
Endoscopic surgery
Controled trials
El Texto completo está disponible en PDF
Bibliografía
[1.]
A. Cuschieri.
Whither minimal access surgery: tribulations and expectations.
Am J Surg, 169 (1995), pp. 9-19
[2.]
A. Johnson.
Laparoscopic surgery.
[3.]
A. Cuschieri.
Shape of things to come. Expectations and realism.
Surg Endosc, 8 (1994), pp. 83-85
[4.]
E.M. Targarona, E. Delgado, M. Trias.
Cirugía laparoscópica: expectativas y realidades.
Cir Esp, 67 (2000), pp. 299-303
[5.]
J.B. Mathews.
Minimally invasive surgery: how goes the revolution?.
Gastroenterology, 116 (1999), pp. 513
[6.]
L. Köhler.
Endoscopic surgery: what has passed the test?.
World J Surg, 23 (1999), pp. 816-824
[7.]
H.J. Kreder.
Evidence-based surgical practice: what is it and do we need it?.
World J Surg, 23 (1999), pp. 1232-1236
[8.]
C. Pera.
Cirugía basada en evidencias.
Jano, 54 (1998), pp. 167
[9.]
S. Sauerland, R. Lefering, E.A.M. Neugebauer.
The pros and cons of evidence based surgery.
Lang Arch Chir, 384 (1999), pp. 423-431
[10.]
M.I. Solomon, R.S. McLeod.
Surgery and the randomised controlled trial: past, present and future.
MJA, 169 (1998), pp. 380-383
[11.]
G.J. Maddern.
Surgery and evidence-based medicine.
MJA, 169 (1998), pp. 348-349
[12.]
R.S. McLeod.
Issues in surgical randomized controlled trials.
World J Surg, 23 (1999), pp. 1210-1214
[13.]
R. Horton.
Surgical research or comic opera: questions, but few answers.
Lancet, 347 (1996), pp. 984-985
[14.]
M. Baum.
Reflections on randomised controlled trials in surgery.
[15.]
M. García-Caballero, E.A.M. Neugebauer, S. Sauerland, R. Lefering.
Ventajas e inconvenientes de la cirugía basada en la evidencia.
Cir Esp, 67 (2000), pp. 486-496
[16.]
E. Neugebauer, H. Troidl, W. Spangenberger, A. Dietrich, R. Lefering.
Cholecystectomy Study Group. Conventional versus laparoscopic cholecystectomy and the randomized controlled trial.
Br J Surg, 78 (1991), pp. 150-154
[17.]
S. Bouchard, A.N. Barkun, J.S. Barkun, L. Joseph.
Technology assessment in laparoscopic general surgery and gastrointestinal endoscopy: science or convenience?.
Gastroenterology, 110 (1996), pp. 915-925
[18.]
N. Black.
Evidence-based surgery: a passing fad?.
World J Surg, 23 (1999), pp. 789-793
[19.]
A.W. Majeed, G. Troy, J.P. Nicholl, A. Smythe, M.W. Reed, C.J. Stoddard, et al.
Randomised, prospective, single blind comparison of laparoscopic versus small-incision cholecystectomy.
Lancet, 347 (1996), pp. 985-989
[20.]
N. Howes, L. Chagla, M. Thorpe, P. McCulloch.
Surgical practice is evidence based.
Br J Surg, 84 (1997), pp. 1220-1223
[21.]
S.B. Archer, M.M. Sims, R. Giklich, B. Traverso, B. Laycock, B.M. Wolfe, et al.
Outcomes assessment and minimally invasive surgery: historical perspective and future directions.
Surg Endosc, 14 (2000), pp. 883-890
[22.]
T. Kiviluoto, J. Siren, P. Luukkonen, E. Kivilaakso.
Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis.
[23.]
A. Cuschieri, E. Croce, A. Faggioni, J. Jackimowicz, A.M. Lacy, E. Lezoche, et al.
FAES ductal stone study: preliminary findings of multicenter prospective randomised trial comparing two-stage vs single stage management.
Surg Endosc, 10 (1996), pp. 1130-1135
[24.]
S. Lame, A. Rantala, R. Gullichsen, J. Ovaska.
Laparoscopic vs conventional Nissen fundoplication.
Surg Endosc, 11 (1997), pp. 441-444
[25.]
J.E. Bais, J.F.W.M. Bartelsman, H.J. Bonjer, M.A. Cuesta, P.M.N.Y.H. Go, E.C. Klinkenberg Knol, et al.
Laparoscopic or conventional Nissen fundoplication for gastroesophageal reflux disease: randomised clinical trial.
Lancet, 355 (2000), pp. 170-174
[26.]
A.M. Lacy, J.C. García Valdecasas, J.M. Piqué, S. Delgado, E. Campo, J.M. Bordas, et al.
Short-term outcome analysis of a randomized study comparing laparoscopic versus open.
Surg Endosc, 9 (1995), pp. 1101-1105
[27.]
L. Stocchi, H. Nelson.
Laparoscopic colectomy for colon cancer: trial update.
J Surg Oncol, 68 (1998), pp. 255-267
[28.]
L.K. Temple, D.E. Litwin, R.S. McLeod.
A meta-analysis of laparoscopic appendicectomy in patients suspected of having acute appendicitis.
Can J Surg, 42 (1999), pp. 3777-3783
[29.]
L. Meynaud, C. Colin, P. Vergnon, X. Barth.
Wound infection in open vs laparoscopic appendicectomy. A meta-analysis.
Int J Technol Assess Health Care, 15 (1999), pp. 380-391
[30.]
M. Garbutt, N.J. Soper, W.D. Shannon, A. Botero, B. Littenberg.
Metaanalysis of RCT comparing laparoscopic and open appendicectomy.
Surg Laparosc Endosc, 9 (1999), pp. 17-26
[31.]
P.M. Go.
Overview of randomized trials in laparoscopic inguinal hernia repair.
Semin Laparosc Surg, 5 (1998), pp. 238-241
[32.]
R.S. Chung, D.Y. Rowland.
Meta-analysis of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs.
Surg Endosc, 13 (1999), pp. 689-694
[33.]
L.T. Witt, L. Mathus, C. Hey, B. Rademaker, D.J. Gouma, H. Obertop.
Open versus laparoscopic adjustable silicone gastric banding. A prospective randomized trial for treatment of morbid obesity.
Ann Surg, 230 (1999), pp. 800-807
[34.]
J.S. Azagra, M. Goergen, J. Ansay, P. De Simone, P. Vanhaverbeek, L. Devuyst, J. Squelaert.
Laparoscopic gastric reduction surgery. Preliminary results of a randomized, prospective trial of laparoscopic vs open vertical banded gastroplasty.
Surg Endosc, 13 (1999),
Copyright © 2001. Asociación Española de Cirujanos
Descargar PDF
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Quizás le interese:
10.1016/j.ciresp.2021.07.006
No mostrar más