[Laparoscopic surgery in Europe. Where are we going?]

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Surgical Innovation

Context:

• Laparoscopic surgery (LS) has evolved significantly due to technological progress and visionary surgeons.
• LS has generated considerable debate, concerns, and medico-legal issues.
• Despite advancements, several key controversies in LS persist.

Purpose:

• To review the evolution of laparoscopic surgical approaches.
• To classify current instrumental technology in laparoscopic surgery.
• To analyze current laparoscopic surgical practices and their patient outcomes.
• To discuss future directions and challenges in laparoscopic surgery.

Summary:

• The article examines the historical development of laparoscopic surgery, including various approaches like capnoperitoneum, gasless, and hand-assisted techniques.
• It categorizes laparoscopic instruments, highlighting facilitating, enabling, and complementary technologies such as the Da Vinci robotic system.
• Current practices are assessed, distinguishing procedures with definitive, probable, and uncertain patient benefits, alongside future developments like endoluminal and robotic surgery.

Impact:

• Provides a comprehensive overview of laparoscopic surgery's current state and future trajectory.
• Addresses unresolved controversies and challenges in training, quality assurance, and resource allocation for laparoscopic surgery.
• Offers insights into the comparative effectiveness of various laparoscopic procedures, guiding clinical decision-making and research priorities.