Introduction

Data are slowly accumulating supporting the concept that the laparoscopic approach to colectomy offers significant early advantages for the management of most colorectal pathology. Data exist regarding the benefits of laparoscopic management of colon cancer and large polyps, diverticulitis, and inflammatory bowel disease. Modified use of these resective techniques can be implemented for reservoir construction in urologic procedures.

The cost-effectiveness of laparoscopic colectomy is related primarily to reductions in duration of hospitalization and a lower incidence of cardiopulmonary complications that lead to a reduced utilization of postoperative diagnostic and therapeutic investigations (1). The earlier recovery of the patient coupled with an earlier return to normal activity offers other potential cost savings to society at large (2).

Initial concerns with laparoscopic colorectal surgery related to technical difficulty, steeper learning curves, a need for specialized instrumentation and longer operating times. Secondary concerns have developed including increased hospital costs, questions about real improvements in outcome and concerns regarding safety in neoplastic disease (3). These factors have led to the slower dissemination of the technique compared to other advanced laparoscopic procedures such as Nissen fundoplication or splenectomy (4). Recent reports of "fast track" care for colectomy patients have further blurred the distinctions between outcome of laparoscopic and open colectomy because of the perception that length of stay can be dramatically reduced with open surgery. However, the majority of data report shorter duration of hospitalization for laparoscopic colectomy compared to open surgery (5-9).

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