The Influence of the Laparoscopic Approach in Abdominal Surgery: The Third Surgical Revolution

Abstract

In the mid-1980s, general (abdominal) surgery was relatively stagnant and at risk of being overshadowed by non-surgical specialties performing less invasive procedures for what had previously been major “open” surgical operations. These challenges to general surgery included flexible endoscopy (removal of mucosal tumours and endoscopic treatment of choledocholithiasis, management of gastrointestinal hemorrhage, endoscopic placement of feeding tubes, etc.) and interventional radiology (percutaneous drainage of abscesses, biopsy of tumor masses, etc.). Furthermore, great efforts were being made to develop non-invasive treatment of gallstones by using extracorporeal shock wave lithotripsy and gallstone dissolution agents. In the late 1980s, surgeons in Germany, France and the United States, working independently, began performing procedures that would revolutionize the practice of general surgery. Using traditional laparoscopic instruments and techniques (CO₂ pneumoperitoneum, trocar/sheath assemblies and long narrow instruments), but coupling the laparoscope to a CCD-video camera, the first laparoscopic cholecystectomies were performed. Although the academic community was slow to embrace the development, practicing surgeons and patients alike rapidly accepted and even demanded this new “minimally invasive” approach to the treatment of gallstones.