Outcomes of Minimally Invasive Surgical Interventions

Abstract

Minimally invasive surgery (MIS) -- encompassing laparoscopic, robotic-assisted, thoracoscopic, and endoscopic approaches -- has progressively replaced open surgery across nearly every surgical specialty over the past three decades. The theoretical advantages are well rehearsed: smaller incisions, less tissue trauma, reduced blood loss, shorter hospital stays, and faster recovery. But the extent to which these advantages translate into measurable outcome improvements varies substantially across procedures, patient populations, and surgical expertise levels, and the premium cost of robotic platforms has added a cost-effectiveness dimension that is increasingly difficult to ignore. We conducted a multicentre retrospective analysis of 18,624 matched surgical cases across four European academic hospitals (Paris, Tallinn, Berlin, and Milan) from January 2015 to December 2021, comparing MIS versus open approaches across four high-volume procedure categories: cholecystectomy, colectomy, lobectomy, and radical prostatectomy. We evaluated five outcome frameworks: perioperative complication analysis, recovery trajectory modelling, oncological equivalence assessment, cost-effectiveness analysis, and patient-reported outcome integration. Our Minimally Invasive Outcome Score (MIOS) integrates complication reduction, recovery speed, oncological adequacy, cost-effectiveness, and patient satisfaction. Laparoscopic cholecystectomy showed the highest MIOS (0.942) with near-universal superiority over open. Robotic prostatectomy achieved the best oncological and functional outcomes (MIOS 0.918) but the worst cost-effectiveness. Thoracoscopic lobectomy (MIOS 0.908) showed the largest absolute survival benefit over open. These findings provide a procedure-specific evidence framework for MIS adoption and resource allocation.