Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15119
Revised: March 21, 2014
Accepted: May 19, 2014
Published online: November 7, 2014
The advances of laparoscopic surgery since the early 1990s have caused one of the largest technical revolutions in medicine since the detection of antibiotics (1922, Flemming), the discovery of DNA structure (1953, Watson and Crick), and solid organ transplantation (1954, Murray). Perseverance through a rocky start and increased familiarity with the chop-stick surgery in conjunction with technical refinements has resulted in a rapid expansion of the indications for minimally invasive surgery. Procedure-related factors initially contributed to this success and included the improved postoperative recovery and cosmesis, fewer wound complications, lower risk for incisional hernias and for subsequent adhesion-related small bowel obstructions; the major breakthrough however came with favorable long-term outcomes data on oncological parameters. The future will have to determine the specific role of various technical approaches, define prognostic factors of success and true progress, and consider directing further innovation while potentially limiting approaches that do not add to patient outcomes.
Core tip: Laparoscopic surgery has been a major revolution in surgery and clearly has become a core technique in colorectal surgery. The paper reviews the evolution of the technology, analyzes its results with regards to patient outcomes, and provides a basis for future research and fine tuning of its applications.