Laparoscopic Cholecystectomy: The Evolution of General Surgery

Laparoscopic cholecystectomy has received an im-mense amount of publicity as the revolutionary new method for the treatment of gallstone disease. Recent reports in newspapers and periodicals have trumpeted this procedure as a technologic breakthrough and have detailed the advantages of a marked reduction in recov-ery time and postoperative pain and a better cosmetic result. Rapidly escalating patient demand and the initial limited availability of instrumentation and appropriately trained surgeons combined to create an aura of unique-ness for laparoscopic cholecystectomy. Although excit-ing, this technique represents not the revolution but rather the evolution of surgery and the culmination of nearly 100 years of effort in the development of surgical technology and techniques. In 1904, Dr. Chevalier Jackson developed a rigid esophagoscope that combined an optical channel with a distal light filament (1). This instrument sparked interest in less invasive forms of visceral evaluation. In 1937, Ruddock reported his experience with peritoneoscopy, using a similar scope to evaluate the abdomen in 500 patients (2). Although it was helpful as a diagnostic tool, the early laparoscope was of little use for the operating surgeon because of limited visualization. Thi