Laparoscopic surgery: expectation and reality

Despite the rapid development and widespread application of laparoscopic op eration techniques, only laparoscopic cholecystectomy and laparoscopic fund oplication have replaced the open operations as standard techniques. Nowada ys only about 10% of appendectomies and 25 % inguinal hernias are performed by the laparoscopic approach. Colorectal operations are rarely performed l aparoscopically. Demanding operative skills and uncertainty about the oncol ogical quality have hindered the spread of laparoscopic colorectal resectio ns. Studies at specialized centers have shown that it is possible to follow the principles of oncological surgery. First results of small series promi se similar long-term results, but large prospective randomized trials are s till unpublished. Depending on the extent of the operative procedure, lapar oscopic operations result in reduced postoperative pain, fewer adhesions, s hortened postoperative atonia and improved convalescence in comparison with open surgery. The direct costs of laparoscopic procedures are higher than open operations as a result of longer operation times and expensive equipme nt. As a result of shorter hospitalisation and quicker return to work, the overall health care costs may be reduced, but strong unbiased evidence is s till lacking.