Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.704
Peer-review started: May 20, 2015
First decision: September 9, 2015
Revised: October 20, 2015
Accepted: December 12, 2015
Article in press: December 14, 2015
Published online: January 14, 2016
The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients’ characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.
Core tip: The introduction of laparoscopy for the treatment of colorectal pathology is associated with the same benefits than other minimally invasive procedures with lesser pain, earlier recovery of bowel transit and shorter hospital stay. Although the use of laparoscopy in colorectal surgery has increased in recent years, several studies have shown that minimally invasive techniques are still underused and there are also substantial differences among centres. Thus, its implementation of the laparoscopic approach requires more efforts in teaching surgeons. We here present a review of recent controversies and the results of latest innovations in the use of laparoscopic surgery for colon and rectal diseases.