ABSTRACT
Since the 1940s surgeons have used a laparoscope to inspect the peritoneal cavity. Advances in equipment technology coupled with pioneering approaches have moved the role of the laparoscope from a diagnostic to an increasingly therapeutic tool in managing abdominal pathology. The first appendicectomy was performed laparoscopically in the 1980s, closely followed by laparoscopic cholecystectomy in 1985. Laparoscopic colonic resection, particularly for cancer, has been slower in development and uptake, however. This is unsurprising, considering the technical challenges involved, including the necessity to operate in all four quadrants of the abdomen and the complexity of the arterial and venous anatomy of the colon. The need to resect and remove a sometimes substantial specimen, and subsequently perform a difficult intestinal anastomosis, are further challenges. When considering mid-to lower rectal cancers, there are additional anatomical and technical difficulties. These include bulky tumours in a narrow pelvis, retraction and visualization (especially with the distal dissection), preservation of autonomic nerves, accurate circumferential resection (without jeopardizing the mesorectal envelope) and technological challenges (due to current limited angulation of laparoscopic staplers).
