Does laparoscopic surgery spell the end of the open surgeon?

Abstract

Barely fifteen years have passed since the laparoscopic era was launched with a cholecystectomy by the French surgeon Philippe Mouret.1 Yet today by far the majority of cholecystectomies are done in this way,2 and laparoscopic surgery finds many other indications. The UK has been slower than some other countries to adopt these techniques; indeed, the President of the Association of Coloproctology, Neil Mortensen, has declared ‘... it is scandalous how far we are behind on keyhole surgery for bowel cancer and other bowel problems’ (Daily Telegraph, 6 May 2003). The range of operations now extends from simple procedures such as herniorrhaphy and ovarian cystectomy to complex operations including radical prostatectomy, nephrectomy, and adrenalectomy.3 Where will this end? Do such techniques spell the demise of open surgery? In discussing this matter we confine ourselves to laparoscopy, though the argument applies also to numerous other procedures whereby open operation is replaced by use of small incisions and long thin instruments, with display of the surgical field on a monitor. The question in our title requires analysis of two key elements: is laparoscopic surgery better for the patient (without unduly hampering the surgeon); and is it practically and financially feasible?