Critical analysis of the laparoscopic approach to colo-rectal surgery based on a personal experience of 613 operations

Initial experience of colo-rectal laparoscopic surgery, after a period of enthusiasm tempered by anticipated technical difficulties, was held back due to reservations made in the case of operations for cancer, following the publication warning surgeons concerning the danger of the development of port-site metastasis. Nevertheless, this type of surgery continued to be developed for benign diseases of the colon, enabling acquiring of the necessary surgical skill. This skill could then applied by experienced surgical teams for the treatment of cancer, that do not seem to show negative aspects, in connection with local recurrences or 5 years survival rates. These reports need to be confirmed by ongoing multi-center trials currently being undertaken in several countries. The advantages of laparoscopic surgery in terms of post-operative comfort having been widely demonstrated it seems that as applied strictly to colo-rectal pathologies, morbidity and mortality of this surgical procedure are at least equal to those of conventional <<open>> surgery. These good results require, however, a relatively long period of training. Based on the experience of 613 patients operated by laparoscopic surgery, the authors highlight the special characteristics of this surgical technique whose future expansion can be expected and is justified.