Endoscopic surgery and evidence-based medicine

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.