Complexity Theory and its relationship with minimal access surgery

EDUMECENTRO 2023;15:e2200



Complexity Theory and its relationship with minimal access surgery

Teoría de la Complejidad y su relación con la cirugía de mínimo acceso


Miguel Licea Videaux1*
Roberto Santana Caballero1
Marbelys Gómez Morgado2


1 University of Medical Sciences of Havana. Clinical-Surgical Hospital "Hermanos Ameijeiras". Havana. Cuba.
2 University of Medical Sciences of Havana. International Orthopedic Scientific Complex "Frank País". Havana. Cuba.


*Author for correspondence. Email:



Submitted: 13/12/2021
Accepted: 29/10/2022



To the editor:

At the end of the 19th century, the deployment of the scientific-technical revolution began, which reached its peak in the 20th century. Medicine, like many other disciplines, incorporated the great advances of science and technology. In the 1980s, medical sciences benefited from the advent of increasingly sophisticated and complex equipment and media.

Complexity Theory emerged in the middle of the 20th century and is defined as the phenomenon that stimulates and develops revolutionary thought, and approaches current problems from a non-linear perspective, thus breaking with traditional paradigms; one of its main contributions is the transdisciplinary work of knowledge and social transformation.(1,2,3)

In order to currently understand and explain a certain complex phenomenon, it is necessary to approach it with an approach based on such theory; this means integrating, gathering, separating, rearming and analyzing such phenomenon and its surroundings, as a whole.

Minimal access surgery as a branch of medicine is part of the network structure of the National Health System. It constitutes a complex system because it interacts with each other and forms a branched network, due to the fact that it extends not only to surgery, but also to other branches within medicine such as gastroenterology, internal medicine, imaging and radiology, anesthesia, intensive care and rehabilitation.

The future development of keyhole surgery is only predictable to a certain extent. This is due to the multiple alternatives that exist for its expansion, making it very laborious to predict where the next great advance will be.

Minimally invasive surgery is not exempt from the influence of internal and external factors. Faced with these stimuli, it reacts in such a way that it tends to seek its state of equilibrium. Whenever new health problems arise, for which minimal access surgery is initially limited, a way will be found to respond to the new dynamics, relying on the application of advances in science and technology.

Thanks to the paradigm of complexity and its application in minimal access surgery, the result of a certain operation is not exact but is expressed as a possibility. Because it is flexible, it is no longer seen as something classic and rigid.

A certain disease can manifest itself in different ways, as well as its treatment, the approach and the way to solve an ailment. Minimal access surgery constitutes one more possibility as a tool in the vast therapeutic arsenal of medicine.

Every complex system feeds back from positive and negative experiences; it is strengthened in the positive ones and takes the lessons from the negative ones. In this way it tries to remain stabilized in attractors. In order to reach a greater creative potential, a correct flow of information between and towards the different components of the complex system is necessary.

The history of every complex system is fundamental, both in the social, political, economic and scientific spheres. The relationship between the development of medical science and minimally invasive surgery within it is inseparable from its history. By not ignoring history, which is translated into databases, the development of research to respond to current health problems is ensured. Nothing is rigid and strict in the complex system; it is not ruled by unbreakable order. To achieve development and evolution, a dose of total disorder or chaos is also necessary. This inseparable balance between order and disorder is what makes the complex system adaptive as well.

The adaptation to the new minimal access surgery in its beginnings, today it achieved the knowledge and ability that one has of it. Understanding the adaptability of complex systems arms the clinician with a valuable tool in dealing with the unexpected.(4)

The complexity paradigm seeks to build communication between the identified object, the environment and the observer as active and inseparable units. In the same way it occurs in the case of minimal access surgery, where the active units are made up of the patient, his illness and the acting physician; the latter with all the necessary instruments at its disposal to solve the health problem.

It is evident that minimal access surgery incorporates the paradigm of complexity as an instrument and working method. This in turn generates thought and knowledge thus eliminating the ambiguous and confusing. By not having a reductionist approach, fragmentary responses and solutions are avoided.(5)

Due to the incessant search for answers and solutions to the different problems that human beings face from the social, physical and biological points of view, they have incorporated a different, more comprehensive vision into their daily life. This complex paradigm, applied to health science and its different specialties, including minimally invasive surgery, in the opinion of the authors, favors progress towards a new form of knowledge production, allowing a better understanding of reality.



1. Ramis Andalia RM. Complejidad y salud en el siglo XXI. Rev Cubana de Salud Pública [Internet]. 2007 [citado 20/10/2021];33(4):[aprox. 10 p.]. Disponible en:

2. Sánchez Ordóñez JM. Desarrollo y salud: la emergencia de un nuevo paradigma. Prospectiva. Rev de Trabajo Social e Intervención Social [Internet]. 2021 [citado 11/12/2021];31:[aprox. 23 p.]. Disponible en:

3. Roque González R. Centro Nacional de Cirugía de Mínimo Acceso, sistema complejo vinculado a la gestión de calidad. INFODIR [Internet]. 2020 [citado 20/10/2021];16(31):[aprox. 10 p.]. Disponible en:

4. Lifshitz Guinzberg A, Pomposo García Cohen A. La ciencia de la complejidad y la educación médica. Inv Ed Med [Internet]. 2017 [citado 20/10/2021];6(24):[aprox. 5 p.]. Disponible en:

5. Salazar JC. El paradigma de la complejidad como alternativa al abordaje del proceso salud-enfermedad desde una concepción social. Acta Odont Venez [Internet]. 2017 [citado 27/10/2021];55(1):[aprox. 5 p.]. Disponible en:



Declaration of interests

The authors declare not to have any interest conflicts.



Contribution of the authors

Miguel Licea Videaux, Roberto Santana Caballero, Marbelis Gómez Morgado: participated in the bibliographic review, preparation and review of the final draft.

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