Laparoscopic surgery for benign and malign diseases of the digestive system: Indications, limitations, and evidence

Abstract

The laparoscopic technique was introduced in gastrointestinal surgery in the mid 1980s. Since then, the development of this technique has been extraordinary. Triggered by technical innovations (stapling devices or coagulation/dissecting devices), nowadays any type of gastrointestinal resection has been successfully performed laparoscopically and can be performed laparoscopically dependent on the patient’s condition. This summary gives an overview over 30 years of laparoscopic surgery with focus on today’s indications and evidence. Main indications remain the more common procedures, e.g., appendectomy, cholecystectomy, bariatric procedures or colorectal resections. For all these indications, the laparoscopic approach has become the gold standard with less perioperative morbidity. Regarding oncological outcome there have been several high-quality randomized controlled trials which demonstrated equivalency between laparoscopic and open colorectal resections. Less common procedures like esophagectomy, oncological gastrectomy, liver and pancreatic resections can be performed successfully as well by an experienced surgeon. However, the evidence for these special indications is poor and a general recommendation cannot be given. In conclusion, laparoscopic surgery has revolutionized the field of gastrointestinal surgery by reducing perioperative morbidity without disregarding surgical principles especially in oncological surgery.

Keywords: Laparoscopy, Gastrointestinal surgery, Esophagus, Stomach, Cholecystectomy, Colorectal surgery, Liver resection, Pancreas resection, Laparoscopic resection of gastrointestinal

Core tip: Laparoscopy is known for more than 100 years. In the last three decades there have been significant innovations in laparoscopic surgery that have revolutionized the field of digestive surgery so that by now every surgical procedure for any benign or malign digestive disease has been performed laparoscopically. This article gives an overview over the development of laparoscopic surgery as well as presents the most recent evidence for laparoscopic surgery with special focus on morbidity and equivalency regarding oncological results compared to the open approach.