Evolution of laparoscopy in colorectal surgery: an evidence-based review

Abstract

Open surgery for colorectal disease has progressed significantly over the past century from humble beginnings to form the mainstay of treatment for colorectal cancer and a number of benign conditions. Following the introduction of laparoscopic abdominal surgery, the next stage in the evolution of the specialty began in the 1990s with the first laparoscopic colonic resection. Following some early concerns regarding its safety and oncological efficacy during the latter part of that decade, laparoscopic colorectal surgery rapidly came into mainstream use in the early part of the current century with evidence supporting its use being made available from large scale randomised controlled trials. This article provides an evidence-based summary of this evolutionary process as it relates to both benign and malignant colorectal disease, as well as discussion of the next phase of new technologies such as robotic surgery.

Keywords: Colorectal cancer; Colorectal surgery; Laparoscopic resection of gastrointestinal; Laparoscopy; Pelvic floor; Robotics.

Figure 1

The author performing a laparoscopic rectopexy for rectal prolapse.

Figure 2

The author at the Da Vinci Si robotic console performing a robotic-assisted ultra-low anterior resection for rectal cancer.

Figure 3

The 4-arm Da-Vinci Si robotic setup for low rectal cancer resection.