Credit Where Credit's Due: Gynecology Paves the Way for MIS (Minimally Invasive Surgery).

Abstract

The introduction of modern-day minimally invasive surgery (MIS) marked a turning point in the history of medicine, driving one of the sharpest declines in surgical mortality and morbidity ever recorded-standing alongside antisepsis and antibiotics as one of the most consequential life-saving advances in medical history. By averting an estimated 10 to 20 million surgical deaths and sparing over 1 billion patients the severe, long-term disabilities once inherent to large-incision approaches, MIS transformed surgical practice across all disciplines within a single generation. As a first-person historical account and companion piece to our systematic outcomes review, this Clinical Opinion reconstructs the lived experience of that paradigm shift: from the haunting realities of 1970s open laparotomy to Camran Nezhat's pioneering transition from eyepiece laparoscopy to monitor-guided operative endoscopy. The author reflects on the personal motivations, technological improvisations, and multidisciplinary collaborations that expanded videoendoscopy beyond diagnostics into complex operative interventions, as well as the fierce institutional resistance that nearly extinguished the movement. Beyond its technical achievements-including dramatic reductions in perioperative blood loss, multiunit transfusions, infections, and hospital stays-MIS catalyzed a fundamental reimagining of surgery itself. It inverted two centuries of surgical doctrine, replacing the belief that "the bigger the incision, the better the surgeon" with a new ethos centered on shared visualization, organ preservation, and pathology-directed precision. Ultimately, this narrative highlights the cost of innovation, the role of patients as the true drivers of progress, and the ongoing obligation to ensure equitable global access to minimally invasive and robotic-assisted care.