Operative Endoscopy Will Replace Almost All Open Procedures

101 Despite being a relative newcomer to surgery, videola-paroscopy, also known as operative or therapeutic laparoscopy) has ignited a revolution in the surgical approach where it has been utilized for virtually every surgically addressed pathological entity. 1 Videolaparoscopic surgery has the predominant means of performing many common surgical procedures. Operative laparoscopy has largely prevailed over the open approach including more than 95% of cholecystectomies, 90% of fundoplications, 70% of ectopic pregnancies, and 50% of benign ovarian cysts. In addition, this minimally invasive approach has prevailed over more invasive open surgical resections in a diverse number of benign and malignant conditions. For example, gastric cancer can be treated with resection or intragastric surgery if diagnosed in its early stages. Videolaparoscopy affords the benefit of a less invasive and less morbid approach for early diagnosis of gastric cancer, ie, " stage the patient in an attempt to spare the patient. " Similarly, patients with biliary tract and liver malignancies currently benefit from the use of staging laparoscopy for the identification of unresectable disease. Colon resection, cystectomy and bladder reconstruction, adrenalectomy, and treatment of pancreatic abnormalities are now all approached via operative laparoscopy. The use of laparoscopy for radical hysterectomy, prostatectomy, and pelvic and paraaortic lymphadenectomy is now prevalent. 1 Morbid obesity, once considered a contraindication for laparoscopy, has now yielded to the clear advantages that laparoscopy presents. In one of the few randomized, controlled trials comparing open and laparoscopic approaches , patients undergoing gastric bypass laparoscopically had significantly fewer complications and a shorter length of stay than those patients who had open gastric bypass. 2 In my opinion, laparoscopic surgery should be the procedure of choice for pelvic and abdominal pathologies in obese and morbidly obese patients. In my experience, it is amazing how well these patients do when managed laparoscopically. Has Darwinian natural selection lead to the evolution of surgery favoring the laparoscopic approach? Clear advantages of videolaparoscopic surgery over open surgery seem to drive an ongoing selection process following time-honored principals of surgery: identification of anatomy and exposure and use of proper surgical technique. Laparoscopy offers better visualization and exposure, therefore, easier identification of anatomical relations. The superiority of laparoscopic surgery extends to several other parameters: reduced perioperative stress, diminished intraoperative and postoperative complications, fewer adhesion formations, lower cost, shorter convalescence period, and improved quality of life. The incisions provide better cosmesis. Surgeons are no longer crouching over while operating …