John Wickham's New Surgery: 'Minimally Invasive Therapy', Innovation, and Approaches to Medical Practice in Twentieth-century Britain

Abstract

The term 'minimally invasive' was coined in 1986 to describe a range of procedures that involved making very small incisions or no incision at all for diseases traditionally treated by open surgery. We examine this major shift in British medical practice as a means of probing the nature of surgical innovation in the twentieth century. We first consider how concerns regarding surgical invasiveness had long been present in surgery, before examining how changing notions of post-operative care formed a foundation for change. We then go on to focus on a professional network involved in the promotion of minimally invasive therapy led by the urologist John Wickham. The minimally invasive movement, we contend, brought into focus tensions between surgical innovation and the evidence-based model of medical practice. Premised upon professional collaborations beyond surgery and a re-positioning of the patient role, we show how the movement elucidated changing notions of surgical authority.

Keywords: innovation; minimally invasive; radiology; surgery; technology.

Figure 1:

A table from John Wickham’s introductory editorial to the first issue of Minimally Invasive Therapy in 1991. In it Wickham envisioned the future organisational structure of ‘interventional therapy’, with the role of open surgeon reduced to a comparatively minor position of equal status to endoscopists, radiologists and others (reproduced with the permission of the author)