Minimally invasive mitral surgery: dangerous to dabble.

Area of Science:

• Cardiothoracic Surgery
• Surgical Innovation
• Medical Technology Assessment

Background:

• New surgical techniques, especially in cardiac surgery, carry inherent risks due to small margins for error.
• Buxton's law highlights the difficulty in evaluating new procedures, often delaying assessment until it's too late for unbiased results.
• The 'learning curve' phenomenon, particularly in minimally invasive surgery, describes the reluctance to rigorously assess techniques during the early, variable operator learning phase.

Purpose of the Study:

• To analyze the challenges and implications of evaluating new surgical techniques.
• To discuss the conflict between early assessment and operator learning in surgical innovation.
• To highlight the risks associated with delaying rigorous evaluation of novel surgical procedures.

Main Methods:

• Literature review and conceptual analysis of surgical innovation adoption.
• Examination of Buxton's law and the 'learning curve' in surgical practice.
• Discussion of the balance between pre-emptive assessment and delayed access to new treatments.

Main Results:

• A reluctance exists to rigorously evaluate new surgical techniques during their early adoption phase.
• Delaying evaluation until a technique is well-established prevents unbiased assessment and can hinder the adoption of best practices.
• The combination of avoiding early assessment and delaying access to potentially beneficial procedures creates a system that compromises rigorous evaluation.

Conclusions:

• The introduction of new surgical techniques requires a balanced approach to evaluation.
• Addressing the 'learning curve' and Buxton's law is crucial for safe and effective surgical innovation.
• A system that prevents rigorous evaluation and denies timely access to optimal treatments must be avoided to ensure patient benefit.