For the past 150 years, morbidity and mortality for surgical procedures have been tacitly accepted as unavoidable parts of the therapeutic process. Since the late 1980s, however, it has become evident that less invasive interventional methods have reduced risks of death and morbidity. This realization has given rise to the concept of minimally invasive surgery, which aims to “minimize the trauma of any intervention process but still achieve a satisfactory therapeutic result.”<sup>117 Wickham J.E.A. Minimally invasive surgery: Future developments Br Med J 1994 ;  308 : 193

Cliccare qui per andare alla sezione Riferimenti</sup> A 1994 United Kingdom Department of Health report predicted that within the next decade 70% to 80% of surgical procedures would be performed endoscopically.<sup>124 Working Group of Department of Health and the Scottish Department of Home Health   Minimal Access Surgery: Implications for the NHS Edinburgh: HM Stationary Office (1994). 

Cliccare qui per andare alla sezione Riferimenti</sup> The key feature of this technology-dependent, minimal access surgery is that it produces significantly less trauma than do conventional open procedures.

In the early years, the technique of laparoscopic surgery was applied to only young, healthy patients. With growing surgical expertise and continuing improvements in technology, however, minimal access surgery is being performed on a much broader patient population and a wide range of indications as the list below indicates:

Laparoscopic procedures are being undertaken in elderly patients with multiple comorbid conditions, the very young, the morbidly obese, pregnant women, and the critically ill. In these patient populations, the risks associated with general anesthesia can be compounded by the physiologic changes induced by pneumoperitoneum and patient positioning.

There are few prospective, randomized, controlled trials comparing open and laparoscopic approaches to surgery and their resultant physiologic effects. Indeed, these studies would now prove difficult to undertake given the wide public knowledge and expectation of “keyhole surgery” and its potential advantages. There are, however, many observational and prospective studies assessing the physiologic consequences of peritoneal insufflation, alterations in patient position, and other interventions inherent in laparoscopic surgery.