腔镜外科
1.Diseases that harm call for treatments that harm less.
—— William Ostler, 1849——1919
【译文】带来伤害的疾病呼唤伤害尽量少的治疗。
2.The origins of the words laparoscopy and endoscopy are traced back to the archaic period and later to the classical years of ancient Greece.The everlasting semantic of these origins is revisited in the 21st century, as minimization of surgical trauma with the aid of modern technology substantiates the diachronic objective "to do no harm".
—— A.I.Antoniou
【译文】腹腔镜手术和内镜手术这两个词的起源可以追溯到古风时代以及后来古希腊的古典时期。这些初心中的永恒语义在21世纪得到重新审视，手术创伤最小化的理念在现代技术的帮助下终于让“不伤害”这一长期追求的目标梦想成真。
3.The evolution of laparoscopic surgery is in progress and the field is open to those minds who are challenged by a desire to "do it better".
—— Michael S.Kavic
【译文】腹腔镜手术的演变与发展正在进行中，这个领域对那些渴望“做得更好”的人开放。
4.The goal of minimal access surgery is to diminish the trauma of access without compromising the overall goal of the surgical procedure.
—— Gerald M.Fried
【译文】微创手术的目的是，在不影响手术总体目标的前提下减少手术创伤。
5.Seeing with enlargement is the prerequisite for the success of this new surgical concept.For me, this is the reason minilaparotomy is wrong.It cannot be rescued from its uselessness even using controlled clinical studies.
—— Hans Troidi
【译文】有足够放大的视野是这一新的外科概念成功的重要前提。以我之见，这也正是“小剖腹”手术错误之所在，即使有临床对照研究，也无法改变后者的劣势。
【考注】本句话摘自德国科隆大学Hans Troidl 博士1999年发表的 “First Step: The Idea.（World J.Surg.23, 754-767, 1999）”一文。作者认为旧式“钥匙孔手术”和“小切口手术”最致命之处是视野太小，既看不清，也限制了万一发生意外时的及时准确处理，所以他认为充足的视野是“微创手术”革命性的进步。
6.Personally I do not know the pioneers of endoscopic surgery well.Many of the pioneers ...are open-minded thinkers, are enthusiastic about their work (even passionate), are hard workers, have other interests, have time to enjoy their lives,have an innocent nature, see the abnormal (the normal probably bores them), and they are venturesome.Their colleagues (the normal people) consider them crazy,exotic, outsiders; they are laughed at, mocked, and even fought.
—— Hans Troidi
【译文】就我个人而言，我不太了解内窥镜手术的那些先驱。许多开拓者……他们思想开放，工作热情（甚至激情昂扬），工作努力，兴趣广泛，有时间享受生活，天性率真，善于洞见不寻常（寻常反倒令他们生厌），乐于冒险。他们的同事（那些寻常人）视他们为疯子、异类、外来人，嘲笑、轻慢他们，甚至和他们干仗。
【点评】与上句来自同一篇文章，该文旁征博引，针对当时腹腔镜手术在全世界许多地方广受非议的现实，回顾了历史上科学界，也包括医学界许多新理念、新技术从萌发到非议，最后被接受的许多故事，试图探索其中的一般规律。
从中国大陆腔镜手术的发展轨迹来看，也符合上述规律。最早接受腔镜手术理念，愿意进行尝试与探索的外科医生群体多是少壮派或青年才俊，他们年轻、思想开放、激情昂扬，天性率真，敢于冲破藩篱，兴趣广泛，会生活。
7.Laparoscopy has a definitive role in cases where the trauma of incision is greater than that of excision.
【译文】当切口创伤大于切除创伤时，腹腔镜的优势最明显。
【点评】最典型的代表是胸外科手术。
8.There is little question that laparoscopic cholecystectomy was one of the first truly consumer-driven medical advances.It was fueled in part by the application of exotic technology (including lasers, CCD chip cameras, mechanical clips, and suture and stapling devices) to a common operative procedure and by the public's growing awareness that laparoscopic surgery could reduce postoperative pain and morbidity.
—— Michael S.Kavic
【译文】毫无疑问，腹腔镜胆囊切除术是第一个真正由消费者驱动的医学进步。一些非医学的“外来”技术（包括激光，CCD 芯片相机，机械夹，缝合和吻合器等）在常规手术操作中的成功应用，以及公众有关腹腔镜手术可以减少术后疼痛和并发症这种意识的不断增长，都在不同程度上推动了这一医学进步。
【考注】Michael S.Kavic曾任Journal of the Society of Laparoscopic &Robotic Surgeons编辑部主任。
9.Equipment and instrumentation have a much greater impact and importance in laparoscopic surgery than in open surgery.This is caused by the fact that visualization as well as tactile exploration of the operative field is always only indirectly achieved through optical systems and instruments.
—— C.Palanivelu
【译文】与开放手术相比，腹腔镜手术中的设备和器械对手术具有更大的影响和重要性。原因在于手术野中的视觉和触觉只能通过光学（电子）系统和器械间接实现。
【点评】因此，腹腔镜手术技术的广泛推广和普及反过来极大地推动了相关设备和器械的市场需求。据估计，到2026年，与腹腔镜设备和器械直接相关的市场将从2021年的123亿美元增至221亿美元，年复合增长率为12.5%。
10.There are warnings all around us - the flexible colonoscope led to a growth of industry of removal of barely visible quasi-polyps.The flexible gastroscope led to repetitive gastroduodenal endoscopic investigation for chronic remunerative gastritis.Minimal-access surgery should not be exploited along similar lines.
—— Alexander J.Walt, 1923——1996
【译文】 应该引起我们警惕的是——纤维结肠镜的问世推动了对裸眼几乎看不见的准息肉进行切除的“工业式”增长需求。纤维胃镜则带来了对那些“慢性有利可图胃炎”的反复胃十二指肠镜检查。但愿微创外科不要再沿这条路走下去。(https://www.daowen.com)
【点评】笔者有同感。
11.We are looking at a glass of beer.Open surgery is the beer; laparoscopy is the foam.
—— Herand Abcarian
【译文】我们正盯着一杯啤酒，开腹手术是啤酒，腹腔镜手术是泡沫。
【点评】现在看来，越来越多的泡沫正在沉淀为啤酒。
12.The world might look brighter through the (laparoscopic) camera, but not everything bright is gold.
—— Moshe Schein
【译文】通过（腹腔镜）的摄像头看见的世界更明亮，但并非所有明亮的东西都是金子。
13.[Minimal invasiveness] for patients is now such a matter of fashion that patients would prefer to have a less effective, micro-invasive procedure rather than a mini-invasive, more effective procedure, which is in my opinion simply idiotic.
—— Scopinaro
【译文】（微创）对患者来说，现在是个时尚问题，患者宁愿接受一个不那么有效，但却微创的手术，而不是一个创伤大一点、更有效的手术，在我看来，这就是个白痴。
【点评】不应把手术创伤大小与手术效果和手术安全对立起来。
14.After some of those advanced minimally invasive procedures the patient advances to the recovery room but the surgeon may need an ICU.
【译文】做完一些高难微创手术后，患者进了恢复室，但外科医生可能要进ICU。
【点评】我做第一例腹腔镜下胰十二指肠切除术时就有这种感觉。
15.Diagnostic laparoscopy could be viewed as a controlled penetrating abdominal trauma.
—— Moshe Schein
【译文】诊断性腹腔镜可被视为一种有限的穿透性腹部创伤。
【点评】从上述几段话中，我们可感受到微创外科探索与推广路上的阻力。
16.How do you diagnose bile leak after NOTES cholecystectomy? By a bitter taste in the vagina.
—— Herman Smith
【译文】NOTES胆囊切除术后如何诊断胆漏？尝尝阴道是否有苦味？
【点评】可见该大师对NOTES（经自然腔道内镜外科手术）有多么的反感！
17.Despite widespread usage, awareness about electro- surgical principles and its potential complications are scanty among its users and gynecologists are no exception.
—— Helder Ferreira
【译文】尽管各种“电（能量）-手术器械”被广泛使用，但使用者中（包括妇科医生）对其原理及其潜在并发症的认知甚少。
18.As surgeons, we must understand the energy sources that we wheel into the operating room.The extent of our knowledge should not begin and end with "which button to push"; rather, the basic nature of the energy and its potential complications and side effects should be appreciated for us to be effective caretakers of our patients' interests.A more complete understanding of the principles and potential pitfalls of our energy sources should enhance patient safety.
—— Nathniel J.Soper
【译文】作为外科医生，必须了解我们推进手术室的各种能量源。我们的知识不应该局限于“该按哪个按钮”；而应该了解其基本性能以及潜在并发症和副作用，以有效维护我们患者的利益。全面了解原理和潜在缺陷有利于提升患者的安全性。
19.Surgery is going through a rapid growth spurt as advancements in technology continue to be adapted to the OR.This is a stimulating time.The rate of innovation holds great promise for the rapid advancement of patient care.As previously distinct technologies such as surgery, endoscopy, and radiology continue to overlap in the ORs in the future, surgeons will be progressively challenged to embrace and master new techniques throughout their careers.In this landscape,simulation is predicted to feature prominently as a key training tool for surgeons of all disciplines.
—— Gerald M.Fried
【译文】随着技术进步不断适应手术室发展的需要，外科手术正进入快速发展期。这是一个令人兴奋的时代。创新速率为患者诊疗技术的快速发展带来了巨大的希望。由于外科手术、内镜技术和放射学等这些从前互不关联的技术在未来手术室中的持续相互渗透，外科医生将在其职业生涯中将逐步接纳和拥抱这些新技术的挑战。值此背景下，可预见的是模拟技术将成为未来各专业外科医生特征性的关键培训工具。
20.Keeping pace with changes in surgical technology and innovation can be daunting given the often rapid pace of technologic advancement and number of potential new technologies surfacing at any one time.A proposed mechanism to quantify and even predict emerging technologies in surgery is to track trends in the types of peer-reviewed publications and patent applications within surgical technology domains.It has been shown that new technologies that eventually become mainstream follow a sigmoidal pattern of prevalence of usage, with relatively little use at first (innovation phase), then increasing use (early adopter phase), then widespread acceptance (late adopter phase), and finally plateauing(maintenance phase).Literature publication and patent application numbers have been shown to follow this same pattern except that they precede the usage curve,meaning that such measures could serve as predictors of which technologies are likely to become adopted into the mainstream.Most recently, patent applications and peer-reviewed publications in surgical robotics and image guidance technology have emerged as front-runners, suggesting these domains may become the next fields from which the new technologies with the most impact develop.
—— Gerald M.Fried
【译文】通常，技术进步的速度往往很快，大量潜在新技术可能随时涌现，故要跟上其步伐任务艰巨。可供推荐的一种可量化，甚至可预测外科领域新兴技术的方法是——跟踪外科技术领域内同行评审出版物和专利申请所属类型的趋势。已证明，最终成为主流的新技术遵循S型的应用普及模式：最初，使用相对较少（创新阶段）；之后使用增多（早期应用阶段）；然后被广泛接受（后期应用阶段），最后达到稳定（保持阶段）。文献出版和专利申请数量也遵循同样的模式，只不过其先于应用曲线，这些方法可用来帮助我们预测哪些技术可能成为主流。最近，外科手术机器人和图像引导技术方面的专利申请和同行评议的出版物已经成为领跑者，表明这些领域可能成为下一个最具影响力的新技术发展领域。