Article
“Minimally invasive” – incorrect anticipation of science or scientific term?
„Minimal intensiv“ – fehlende Vorwegnahme des Wissenschaftsprozesses oder wissenschaftlicher Terminus?
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Authors
-
Alfred Aschoff
- Ruprecht-Karls-Universität Heidelberg, Neurochirurgische Klinik (ehemals), Heidelberg, Deutschland
| Published: | June 26, 2020 |
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Outline
Text
Objective: In 1966 the term "minimally invasive" (MI) was cointed for carcinomas in situ (Barter). For 18 years MI was used in this precise original meaning 0-4 times per year only. Later on the term spreaded arbitrarily in the overall medicine into 81,107 papers (PUBMED 11/2019).
Unfortunately the term "minimally invasive" has a threefold semantic:
- 1.
- local malignomas,
- 2.
- a normative meaning closed to the ultimative aim of every medicine ("nil nocere"),
- 3.
- as inaccurat substitute of precise terms such as endoscopic, endovascular, etc. procedures.
The term oscillates uncontrollably between 2 and 3.
Methods: The terms MI/MIN (minimally invasive neurosurgery) were systematically screened in PubMed.
Results: MI was created in 1966, remained a rarity over 15 years and increased slowly in the 80ties. From 1990 to 2018 MI-articles exploded from 53 to 7806 per year and reached now 81,107. In neurosurgery MIN was created in 1985 (stereotactic removal of ventricular catheter. Blacklock) followed by Ascher (Laser trends in minimally invasive treatment, 1991) and Hellwig/Bauer (Minimally invasive neurosurgery by means of ultrathin endoscopes, 1992). From 1991 to 2018 the MIN-papers increased from 2 to 544/per year; now 5025. Old, but precise terms such as stereotaxy (Goodlee 1885), endoscopy (Desormeaux 1865), endovascular (Grüntzig 1979) were substituted by the diffuse euphemistical term MI, which suggests, but not confirms less sideeffects, dangers and pain. Paradoxical effects are common: The ETV has a lethality of 0.28% (8/2985; Bouras 2011; 0.4% Tefre 2018), but is "minimally invasive"; shunts with a peri-operative mortality of 0.1% are are "invasive" (Di Rocco 1994).
Conclusion: Scientific language requires precision, unambiguity and a crystal-clear distinction between descriptive and normative terms. The aprori-declaration of a treatment as MI anticipates any empiric evaluation and should be avoided. MI belongs in the world of advertizing, not of science. MI disturbs and delays critical evaluations.
