Vierra M
Department of Surgery, Stanford University School of Medicine, California 94305-5408, USA.
Annu Rev Med. 1995;46:147-58. doi: 10.1146/annurev.med.46.1.147.
With the widespread introduction of laparoscopic cholecystectomy in late 1989, the practice and expectations of general surgery were changed forever. The techniques of laparoscopy were not new--they had been adopted by gynecologists and orthopedic surgeons at least a decade before--but it was laparoscopic cholecystectomy that captured the attention of the surgical profession and the public and spawned the tremendous growth in what has come to be called minimally invasive surgery. Although this surgery has tremendous appeal, offering quicker recovery, less pain, and possibly greater safety, it presents new challenges in the areas of training, credentialing, and quality assessment and raises serious questions about the real benefits of new technology at a time when the political and economic sensitivity of these issues is greater than ever. In this chapter I limit myself to a discussion of laparoscopy in general surgery, with a focus on what we have learned from laparoscopic cholecystectomy and on what this knowledge suggests for the future of other laparoscopic general surgical procedures.
1989年末腹腔镜胆囊切除术广泛应用后，普通外科的实践和期望从此永远改变。腹腔镜技术并非新生事物——至少在十年前就已被妇科医生和骨科医生采用——但正是腹腔镜胆囊切除术引起了外科界和公众的关注，并催生了后来被称为微创手术的巨大发展。尽管这种手术极具吸引力，能实现更快康复、减轻疼痛且可能具有更高安全性，但它在培训、资质认证和质量评估方面带来了新挑战，并且在这些问题的政治和经济敏感性比以往任何时候都更高的当下，引发了关于新技术实际益处的严重质疑。在本章中，我将把讨论局限于普通外科中的腹腔镜手术，重点关注我们从腹腔镜胆囊切除术中学到的知识，以及这些知识对其他腹腔镜普通外科手术未来发展的启示。
