[Laparoscopic surgery--an update of current status]

Recent developments have allowed most intra-abdominal procedures to be performed by the laparoscopic technique. Potential clinical advantages are supported by the reduced pathophysiological changes demonstrated in the surgical stress response, as compared with open surgery. However, a critical assessment of randomised, controlled studies and meta-analyses comparing laparoscopic and open surgery has not convincingly shown that laparoscopic surgery improves the outcome, except in a few operations. Because the concept of minimal invasive surgery is based on well-documented pathophysiological advantages, future randomised studies comparing laparoscopic and open surgery should include a revision of perioperative care regimens with early rehabilitation, in order to demonstrate more significant benefits of laparoscopic surgery.