[Digestive surgery using the celioscopic route. Prospects for the future]

Digestive surgery through the laparoscopic approach started to develop in March 1987 when the first laparoscopic cholecystectomy was performed. Thanks to the quick success achieved by the pioneers, most of the surgeons soon became aware of the advantages of the method. In the history of surgery, very few procedures have been fortunate enough to cause such a radical and sudden change in each surgeon's daily practice. Over a period of eight years, all the major procedures in digestive surgery have been performed through the laparoscopic approach ; it is now time to evaluate them. Only laparoscopic cholecystectomy has satisfied all the requirements for official approval, thus becoming the gold standard for the treatment of gallbladder lithiasis. However, the use of laparoscopy in the treatment of digestive diseases has already led to a number of major achievements, which makes it possible to outline its prospects. It will develop along two main lines, the first one being gradual transformation of open surgical procedures into laparoscopic procedures through adaptation of operative manoeuvres and design of new instruments. Any surgeon can achieve this transformation provided that he gets specific training. The second line of development will be the integration of high technologies into operative procedures. But this can only be achieved by multidisciplinary institutes endowed with huge financial resources. Patients derive such benefit from laparoscopic surgery that its practise has now reached the point of no-return. Laparoscopic surgery is part of the general evolution towards treatments involving less and less adverse side-effects. It is no doubt the surgery of the future.