Laparoscopic Advances in General Surgery

Originally described in 1901, laparoscopy was used by gynecologists as a surgical approach throughout most of the 20th century. Its applicability to general surgery was popularized in 1987 when laparoscopic cholecystectomy was first performed.¹ Subsequently, minimal-access approaches have been used by general surgeons for multiple intra-abdominal operations because of perceived reductions in patient discomfort and disability, shorter hospital stays, and more rapid return to work.² Now the term minimally invasive surgery encompasses several variations on the purely laparoscopic approach. This general term can mean several different things including a pure laparoscopic approach (all incisions ≤1 cm), a hand-assisted approach in which access large enough to accommodate the surgeon's hand is made to facilitate the procedure (largest incision, 6-8 cm), or a laparoscopic-assisted procedure, some of which is performed in the traditional open fashion (largest incision >4 cm). The approach used is based upon the training, experience, and skills of the surgeon as well as the pathologic process being treated.