ABSTRACT
Laparoscopic colonic procedures were introduced in the early 1990s. By decreasing the size of the incision and operating within the closed abdominal cavity, laparoscopic colorectal surgery provides a method of performing colectomy which results in less postoperative pain, shorter hospital stay, fewer complications, and more rapid convalescence. The operative dissection must be equivalent to that performed in open surgery, particularly in cancer cases. It is important to realize that the laparoscope is a surgical tool and should be used where appropriate. Not all patients are suitable for a laparoscopic approach and limiting factors include obesity, tumor size and fixity, adhesions from previous surgery, low rectal cancer, and the male pelvis. As a general rule, patients should have a body mass index of less than 35. In morphologically challenging patients, it may be necessary to perform a hybrid procedure creating a larger incision, usually in the lower abdomen, to complete the procedure. Alternatively, a hand-assisted (HALS) approach can be considered. Timely conversion when progress falters is not a failure but shows good judgment.
