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World J Gastroenterol. Nov 7, 2014; 20(41): 15119-15124
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15119
Evolution and future of laparoscopic colorectal surgery
Andreas M Kaiser
Andreas M Kaiser, Department of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
Author contributions: Kaiser AM contributed to the whole process of the manuscript.
Correspondence to: Andreas M Kaiser, MD, FACS, FASCRS, Professor, Department of Colorectal Surgery, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 7418, Los Angeles, CA 90033, United States. akaiser@usc.edu
Telephone: +1-323-8653690 Fax: +1-323-8653671
Received: October 29, 2013
Revised: March 21, 2014
Accepted: May 19, 2014
Published online: November 7, 2014
Processing time: 377 Days and 9.5 Hours
Abstract

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.

Keywords: Laparoscopic; Laparoscopy; Open surgery; Colorectal surgery; Colectomy; Robot

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.