Is laparoscopic surgery really evidence-based in everyday practice? Results of a prospective regional survey in France

OBJECTIVE: Evidence-based medicine is a growing paradigm in health care. We conducted a prospective study to determine whether laparoscopic surgery is truly evidence-based in everyday practice. METHODS: A prospective regional survey was performed in 11 French hospitals (one university and 10 district hospitals) to ascertain how general laparo scopic surgery was conducted during the last 3 months of 1997 We also searc hed the electronic databases for original articles on laparoscopic procedur es. The methodology of randomized trials was analyzed and procedures were c lassed by level of evidence. We assumed that an evidence-based procedure wa s which had been validated by well-designed randomized controlled or prospe ctive trials giving homogeneous results. RESULTS: One half of the procedures performed had been evaluated by randomi zed controlled trials. Among the 428 laparoscopic procedures, 334 (78%) wer e found to be evidence based (CI 74. 1-81.9%). Twelve of the 18 indications for laparoscopy (67%) were evidence based (CI: 62.5%-71.5). There was no d ifference between university teaching hospitals and general district hospit als. CONCLUSION: Contrary to initial criticisms, the practice of laparoscopic su rgery appears to be truly evidence-based in the majority of cases.