Minimally invasive surgery (MIS) offers faster recovery and smaller incisions but is limited by persistent visualization issues such as lens fogging, debris, and camera instability. These challenges compromise surgical performance, increase complications, and elevate healthcare costs. This review evaluates the clinical and economic impact of suboptimal visualization in MIS and explores potential solutions. A systematic review was conducted using peer-reviewed literature from January 1990 to August 2024. Studies included those examining visualization challenges in laparoscopic and robotic MIS, clinical outcomes, surgeon-reported frustrations, and cost analyses. Exclusion criteria included studies with significant conflicts of interest, especially those funded by medical device companies. Surgeons spend an estimated 40% of MIS operating time under suboptimal visual conditions, contributing to nearly 20% of surgical complications. Lens cleaning adds 132-493 per procedure, averaging 312. 53 based on 9. 7 cleaning events per case. Visualization-related complications contribute an additional 251 per case. Combined, these issues result in over 2. 2 billion in annual costs in the U. S. Poor visualization also disrupts workflow, increases surgeon fatigue, and hinders integration of emerging technologies such as artificial intelligence (AI). Suboptimal visualization in MIS stands to significantly affect patient safety and healthcare costs. Addressing these challenges through standardized cleaning protocols, improved surgeon training, and adoption of advanced technologies-including AI-driven imaging-is essential. Enhancing visualization is not just a technical upgrade but a critical step toward safer, more efficient, and cost-effective surgical care.
Dhingra et al. (Wed,) studied this question.