2001 Presidential Address

1 It has been a decade since the inception of the Society of Laparoendoscopic Surgeons. The members of this society have initiated and implemented significant and creative progress over the past 10 years by " pushing the envelope " to improve surgical health care using new technologically sophisticated approaches to surgical intervention. The progress has been dramatic. Significant factors in the environment have supported the advancements in minimally invasive surgery. Let us examine the cultural forces that have allowed us to move dramatically forward through the millennium. In reviewing the 10-year progress of minimally invasive surgery, we have the opportunity to compare these events to other historic influences upon the progress of surgery in the distant past. And, moreover, we dare to propose a model for the future utilizing these assessments. At least 4 factors have supported the exponential growth of minimally invasive surgery in the past decade. These forces include: (1) the energy and enthusiasm of creative surgeons, surgical investigators, and surgical educators; (2) the sound of patients clamoring for the least physically insulting and physiologically demanding surgical therapy with the best outcomes; (3) the role of the medical device industry fueling the creative integration of technology, surgical creative designs, and the clear interest of all stakeholders in shortening hospital stays (abbreviated surgical health care experiences); and (4) the pent-up energy of 20 years of surgical activity relegated to peripheral teaching hospitals. In this highly productive environment, however, there are–and have been–signifi-cant forces directed at halting the forward progress of surgery. These forces include the managed care industry (HMOs), the federal influences that use medicine to balance the budget, and " other stakeholders " competing for the health care dollar. Clearly, the history of managed care has functioned to diminish the use of financial resources in the direct care of patients, has been associated with high nonpatient-related spending and overhead , and has been responsible for progression of serious illness–and even death–in many American patients. The dynamics of " balancing the national budget " in the past 8 years has clearly used a siphon on the health care dollar to fund the budget. Unfortunately–and ashamed-ly–in the latest analyses, the United States ranked a very meager eighth in the use of their percentage of gross national revenue to fund health care. Countries who have surpassed the United States in this analysis include and Mexico. Moreover, as recently as 1998, Medicare …