The human body as a multi-organ coupled homeostatic organism: the core mechanism of the super minimally invasive surgery paradigm

Super minimally invasive surgery (SMIS) has been proposed as a treatment paradigm in which minimally invasive care is evaluated not only by access-related trauma but also by treatment-induced biological disturbance and preservation of organ function. We hypothesize that, when disease-control adequacy is comparable, strategies associated with lower multidimensional homeostatic disturbance will be associated with faster functional recovery and better long-term organ- and patient-centered outcomes. We define an SMIS-concordant strategy by three conditions: adequate disease control; lower measurable treatment-induced disturbance than an appropriate comparator; and preservation or faster restoration of organ and systemic function. Homeostatic disturbance is operationalized as a multidomain construct that may include inflammatory/immune, neuroendocrine, metabolic/nutritional, organ-specific, barrier/microbiome/circadian, functional, and patient-reported domains. Because no validated universal score, weighting scheme, or threshold is available, we propose a comparative measurement matrix rather than a new composite index. The framework yields three falsifiable predictions: SMIS-concordant strategies should produce less early biological disturbance, support a faster return toward baseline, and provide prognostic information for long-term recovery beyond conventional perioperative measures. Early gastric cancer illustrates the approach: in guideline-eligible patients, endoscopic resection preserves the stomach and is associated with lower procedural burden and better quality of life, while preliminary proteomic data suggest less postoperative immune-inflammatory perturbation; gastrectomy remains indicated when curative criteria are not met. SMIS is therefore presented as an integrative treatment-decision framework that requires prospective validation.