[Reduction of surgical access trauma: reliable advantages]

Minimizing the trauma of surgical access is becoming an essential task in modern surgery. The treatment has to become more comfortable for the patient and financial resources have to be considered. Minimally invasive surgery is one of the attempts to achieve this goal. A comparison of surgical procedures, such as cholecystectomy, fundoplication and sigmoid resection in diverticulitis, which are already routinely performed laparoscopically, should be suitable for evaluating whether minor access surgery is really advantageous. The value of minor access may be quantified by different parameters such as influence upon the immunologic function, lung function, postoperative pain, time of hospitalization, return to work and duration of convalescence, as well as a comparison of the effects upon the quality of life index. The data concerning the effects upon immunology are not unequivocal. All in all, the degree of postoperative inflammation seems to be lower after laparoscopic surgery. There is no doubt that there is far less impairment on lung function, the results are better as far as postoperative pain is concerned, and hospitalization and duration of convalescence are shorter. It is also evident that immediately after the operation the quality of life index is superior, which, however, levels out in the course of time. The advantage of minimally invasive surgery is really apparent only after the mastering of the so-called "learning curve" and in cases of benign malignancies. The role of the minor access approach in oncological surgery is, however, not yet defined.