The past, the present, and the future of minimally invasive therapy in laparoscopic surgery: a review and speculative outlook.

It took nearly a hundred years until laparoscopy overlooked the realm of general surgery, but rarely in the history of surgery did we observe a similar revolution. Few surgical procedures have changed so rapidly and so profoundly the daily activities of each surgeon. As with any innovation, laparoscopy represented a robust incitement to test its application to almost all the abdominal districts and soon demonstrated clear advantages in surgery of the spleen, adrenal gland and the urinary tract. Today laparoscopy has proven to actually be the most important advancement also in colorectal surgery since the introduction of surgical stapling, with large meta-analyses demonstrating undeniable advantages also in rectal cancer treatment. To be true, the concept of minimal invasiveness was first applied to the rectum even earlier than laparoscopy when transanal endoscopic microsurgery (TEM) was introduced into clinical practice, and today represents a modern platform with extending indications. Looking at the future, economy is going to influence strategic social decisions of governments, which will condition the development of new technologies. The significant increase in prevention through screening programs will lead to the diagnosis of a vast majority of early lesions, which will favour a further decrease of invasiveness.