The Society of American Gastrointestinal and Endoscopic Surgeons is a leading surgical society, representing over 6,000 general and gastrointestinal surgeons throughout North America and the world. It is my distinct honor to serve as the President and represent the 6,000 surgeons of this great organization. The organization is a vibrant, growing and dynamic society based on its mission to optimize patient care through education, research and innovation. The leadership of this organization recognizes the breadth of the practice as well as the focus of more specialized practices throughout the spectrum of gastrointestinal and endoscopic surgery practiced throughout the world. We all realize that technology changes the way that we take care of patients, and subsequently our primary goal is to supply patients with the access, and the ability, to have outstanding care in all areas.

SAGES will continue to evolve. It is always important to remember that despite our broad based focus we can always bring new initiatives into the forefront. While new initiatives should address our main goal of supplying excellence in patient care, we also serve our members and the public as a whole. Over the last six months SAGES has been able to continue to develop and grow its known core programs including Fundamentals of Laparoscopic Surgery, Fundamentals of Endoscopic Surgery, and other organized and validated educational products to improve the level of care and training. Two new initiatives will be undertaken within the next six months that will further delineate SAGES as a leader in innovation.

TECHNOLOGY AND VALUE ASSESSMENT

The first focus will be on the Technology and Value Assessment Committee. SAGES has long been a leader in technology assessment, disseminating data on new and emerging technology as well as disseminating guidelines on the appropriate use of minimally invasive surgery techniques and technology. This relatively new initiative will be a liaison of these two existing committees and reside within the former Technology Committee. The main goals will be to provide to our membership evidence based descriptions of new technology with assessment on clinical appropriateness and some assessment on the cost and efficiency and value of the device and or technique. Technology in a wide variety of developmental states can be assessed, and the charge of the committee is to develop a common pathway where SAGES members can request a review of new technology and techniques and this request can then be assessed by the committee. When decided upon, these reviews will then be assigned to an unbiased expert team that assess the current data and prepare a written statement concerning the technology. These written statements can come in a variety of different levels depending on the data that is available for the particular technology. The Technology and Value Assessment Committee will consider new technology which is already FDA approved for sale in the United States. After preliminary review the technology will undergo more detailed assessment with several of the possible designations.

1. A Technology Alert which would be most appropriate for newly approved devices without significant clinical data.
2. Safety and Effectiveness Assessment: An assessment of the currently available data to determine if the technology meets criteria for safety and effectiveness, this may or may not include #3.
3. Value assessment: An assessment of the value of the technology for practice, hospital, or surgeons, recognizing the often ambiguous data and the influence of local environments on this parameter.
4. Clinical Guidelines: Clinical guidelines will be more appropriate for well-developed products and or procedures with significant evidence. Guidelines are evidenced based reviews produced and published after an exhaustive review of the germane body of literature that has been analyzed using a literature grading system, culminating a series of best practiced recommendations for clinicians that are anticipated to guide clinical care for 85 to 90% of patients with an indexed clinical condition.
5. Consensus Statement: A consensus statement is appropriately issued for a device and its associated techniques after it is approved by FDA, but with scientific literature less mature than what is required for the guideline. A panel of experts with clinical interests, and clinical expertise, who are free from conflicts, will discuss the device and its procedural reviews, review the available clinical data and consider other components related to determining the proposed value of the device at a round table forum. The conclusions drawn will be prepared for publication and it is anticipated that the device support from this group would be interpreted as support for funded use.

It is the intent of the Technology and Value Assessment Committee to offer a “menu” of appropriate reviews for new technology when requested by a SAGES member. This assessment will help guide clinicians and hospitals in acquiring, providing, and delivering the most appropriate and expert and advanced innovative clinical care.

OPEN TO MINIMALLY INVASIVE SURGERY, IMPROVING ACCESS

SAGES was developed concerning the technique and technology of endoscopic surgery and matured over the development of safe laparoscopic and other minimally invasive surgical techniques. MIS has demonstrated huge advantages to our patients and the community in some clinical scenarios like gallstone disease. Laparoscopic cholecystectomy is clearly the standard of care, and failure to provide the opportunity for laparoscopic surgery for cholelithiasis falls below the standard of care. However the use of laparoscopic surgery in other conditions has not been as well accepted. Despite overwhelming evidence in a variety of other clinical conditions the use of laparoscopy and other minimally invasive techniques for the care of disease processes such as colorectal surgery, incisional hernia, and bariatric surgery remains limited. It should be the goal of a high functioning organization that pledges to provide access and quality care to the public to be charged with providing increased access to our patients. Therefore I challenge our organization to target our efforts to increase the prevalence of minimally invasive surgery.

Changing open to minimally invasive surgery should be a major initiative of SAGES in all areas of focus. This includes education of patients, politicians, insurers and of course, surgeons. Over the next few months our leadership will, via a series of retreats and series of focused conversations, develop goals and tactics to help achieve an increased penetration of minimally invasive and high technology programs to increase the ability of all patients to receive minimally invasive procedures for their disease processes.

One example is the availability of bariatric surgery to the general patient population. A recent report from the Center for Disease Control demonstrated that the obesity epidemic continues to grow rapidly. By the year 2030 more than two-thirds of US population will be deemed obese. Education and prevention should be paramount in our desire to control this modern epidemic. However, once obesity significantly affects an individual the only statistically proven method of controlling this disease process is through bariatric and metabolic surgery. When applied appropriately with minimally invasive surgical techniques, this life saving surgery improves the quality of lives, decreases comorbid conditions and improves longevity for the affected patient. Despite this overwhelming evidence a variety of insurers and now, state medical use committees, have denied access of minimally invasive bariatric surgery to our patient populations. This is one example where SAGES should actively advocate on behalf of our patients to all policy makers to increase access for minimally invasive surgical techniques to our patients.

In summary, it is important that I once again reiterate that it is an honor to serve as the President of SAGES for this year. It has been my pleasure to communicate with many of you directly over the course of this time and I welcome the opportunity to discuss any of these issues with you further. I will strive to continue to provide organizational leadership as SAGES moves towards solidifying its core guidelines, education, and excellence in patient care by continuing to develop our core areas. Specifically, through advances of the Technology and Value Assessment Committee and by spearheading the new initiative of “Open to MIS”, SAGES will continue to grow and expand and maintain its leadership in the field of gastrointestinal and endoscopic surgery.

W. Scott Melvin, MD
SAGES President