Laparoscopic Cholecystectomy: A New Milestone or a Dangerous Innovation?

Minimal access surgery via the operating laparoscope has been performed by our gynaecological colleagues for many years. General surgeons have been slow to develop expertise in the techniques of laparoscopic surgery. The new small television cameras and the excellent colour television reproduction, together with purpose designed instrumentation, have made safe laparoscopic surgery a reality rather than a dream. The first laparoscopic cholecystectomy was performed in France by Phillippe Mouriat of Lyons in 1987. Francois Dubois of Paris, one of the leading pioneers in the field, performed his first laparoscopic cholecystectomy in May 1988. Several other groups commenced later that year. Eddie Reddick of Nashville, Tennessee and Jacques Perissat of Bordeaux, France, performed their first laparoscopic cholecystectomies in September and November of 1988 respectively1-4. These pioneers, as well as others, have developed considerable expertise. By early 1990, Dubois reported 350 cases, Reddick 200 cases, and Perissat 193 patients1. Furthermore, many people have received training in laparoscopic cholecystectomy at major institutions. Laparoscopic cholecystectomy appears to have established itself as an important new technique. Standard open operative cholecystectomy is the "gold standard" for the management of symptomatic gallstones in the gallbladder. It is a little over 100 years since the first successful cholecystectomy was performed by Carl Langenbauch. Operative cholecystectomy has withstood the recent threats of oral drug dissolution therapy and extracorporeal shock wave lithotripsy. Does the advent of laparoscopic cholecystectomy mark a new milestone in management? Alternatively, could this be a dangerous innovation which will lead to morbidity, including common bile duct damage, and life threatening intra-operative haemorrhage requiring rapid laparotomy for control? I believe that laparoscopic cholecystectomy will become a major milestone in general surgery if correctly introduced by adequately trained biliary surgeons with laparoscopic expertise. It is not surprising that the procedure