Digestive surgery through the laparoscopic approach - State-of-the-art and future prospects

After a brief historical survey of the origins of laparoscopic surgery and of its application to the treatment of digestive disease, the author proposes to draw up an inventory of all the laparoscopic digestive procedures performed up to 1996. These procedures will be classified according to a method based on an evaluation on their level of use (LU) first by pioneers, then by specialized surgeons, and finally by general surgeons, over the period of time corresponding to their lifespan. A graph is obtained, called the LU graph, which depicts the relation between time (on the X-axis) and the LU (on the Y-axis). The various digestive procedures performed laparoscopically are then reviewed, organ by organ, giving a privileged place to surgery of the biliary tract, and more particularly to laparoscopic cholecystectomy, which triggered off the laparoscopic revolution. CBD stone removal is also discussed extensively, and for each of these procedures, as for the following, the author lists the indications, the advantages, disadvantages and dangers of use, the degree of validation or nonvalidation through different types of surveys, the current level of use and position on the graph. He also mentions whether new instruments and new techniques have been devised to achieve these procedures laparoscopically. This state of the art in laparoscopic digestive surgery is followed by a description of its future developments along two main lines: gradual transformation of open procedures into laparoscopic procedures, accessible to all through adequate training and 'tutoring', and integration of advanced technology, the privilege of a small number of institutions endowed both with money and human resources. A comprehensive bibliography is provided.