Official organ of the Association of Paediatric Surgeons of Bangladesh Journal of Paediatric Surgeons of Bangladesh Editorial

When it comes to health care delivery, people are now demanding an increase in quality and services and a decrease in cost. Increasing the quality of health care delivery may require that a health care facility invest in new technologies, which may be costly and often involves a steep learning curve for practitioners. Change is the only constant in health care, however, so practitioners need to be aware of the changes that are on the horizon for the health care industry and find ways to successfully deal with the inevitable challenges these changes will bring1. The practice of surgery has changed dramatically over the past three decades. The two main driving forces behind these changes have been advances in medical technology and greater public expectations. Minimally invasive techniques such as microsurgery, fibre-optic endoscopy, laparoscopic and arthroscopic surgery and interventional radiology have broadened the range of therapeutic options2. The types and number of minimally invasive or laparoscopic techniques increase every year. Although minimally invasive procedures were once considered merely a surgical trend, physicians in nearly all surgical specialties now are performing minimally invasive procedures on almost all anatomical areas1. Laparoscopic surgery owes much of its history to the development of endoscopic technique. Early physicians such as the Arabian, Albukasim (936-1013 A.D.), and later in 1805, the Frankfurt-born physician, Phillip Bozzini, were among the first to develop methods to examine body orifices. The first effective open tube endoscope was developed in 1853 by Desormeaux and other physicians including Kussmaul and Nitze refined the original endoscopic models and began utilizing in their medical practice. Laparoscopy or endoscopically examinining the peritoneal cavit