After its initial description in the late nineteenth century, a cholecystectomy was performed through the use of a generous right upper quadrant subcostal incision. While this became the standard of care for surgical gallbladder disease, patients viewed the procedure as a painful endeavor with significant morbidity and prolonged return to normal daily activities. In the early 1980s, however, German surgeon Erich Mühe began experimenting with various methods of minimally invasive gallbladder removal based upon Kurt Semm’s work, and introduced the “galloscope” in 1985. He presented his work at the German Surgical Society in 1986, but was ridiculed for what was described as “Mickey Mouse surgery ”. During the same time period, French surgeon Philippe Mouret successfully performed the laparoscopic approach in 1987 on a young woman 2 hour operating time using a direct-view endoscope and lying on his patient’s right thigh for the majority of the case. Anecdotally, the next morning the patient was seen on morning rounds and being in such good condition on her first postoperative day, she was convinced that her gallbladder had not been removed. Two years later, Mouret and a fellow French surgeon by the name of Perissat presented the new laparoscopic procedures at SAGES. This began a revolution within the surgical community to pursue minimally invasive techniques. Within a year, laparoscopic cholecystectomy was being performed across Europe and in the United States. By 1990 there were well over 50 trade exhibits, clinics, lectures, and courses at SAGES. In 1993, it was estimated that more than 80 % of cholecystectomies were performed laparoscopically. During this time, patient demands for minimally invasive surgeries increased while costs for laparoscopic equipment diminished due to free market competition between medical device companies. The growing demand incentivized hospitals to retrofit their operating rooms to become laparoscopy enabled in an effort to attract patients to their minimally invasive surgical practices.

Small retrospective studies and case series began documenting the increased patient satisfaction, decreased pain, and better cosmesis. Large studies mirrored these same outcomes, but also highlighted the potential drawbacks of laparoscopic operations. Within these studies, however, intolerance of pneumoperitoneum for patients with severe cardiac or pulmonary disease, increased operating difficulty in the obese, and loss of 3D viewing through a monocular video-imaging system all became sited criticisms of laparoscopy. Despite these disadvantages, surgeons began using laparoscopy for multiple indications, from diagnostic purposes to forays in resection of the larger organ systems, including the colon.

The removal of large organ systems such as the colon presented an interesting challenge to laparoscopic surgeons. The first series of laparoscopic colectomies was presented in 1991 and was initially used for benign disease processes such as diverticulitis and inflammatory bowel diseases; however, surgeons began performing laparoscopic colectomies for oncologic resection for malignant neoplasms . Doubts arose about the ability to perform adequate mobilization within certain regions in the abdomen (namely the pelvis), and whether laparoscopic resection could obtain appropriate margins on colon cancers, let alone perform an adequate lymphadenectomy for accurate pathological staging. Moreover, it was well known that laparoscopic surgeries suffered from loss of tactile touch discrimination and the fulcrum effect of introducing linear instruments though a trocar inserted through the abdominal wall. Criticism also focused on removal of a specimen through a small incision, which would (1) likely require large incisions approximating that of open colectomies for larger tumors, and (2) the potential for seeding laparoscopic port sites with malignant cells. By the late 1990s, however, small prospective studies focusing on laparoscopic colon resections began confirming the benefits of laparoscopy over open resections. Laparoscopic colon resections were as adequate in lymphadenectomy for staging and therapeutic purposes, had similar disease free survival as the open counterparts, and tended towards shorter hospital stays and quicker return to work.

Prior to 2004, small studies at single-institutions or case series were prevalent in the surgical literature but were more descriptive of laparoscopic colectomies rather than supportive of their noninferiority to the current standard of care.

In response to these growing concerns from the surgical community, the Clinical Outcomes of Surgical Therapy (COST) study group conducted a prospective multi-institutional, randomized trial that ultimately showed noninferiority when comparing open versus laparoscopic colon resection. Published in 2004, the COST trial randomized 872 patients across 48 American and Canadian intuitions to undergo either open or laparoscopically assisted colectomies with the primary end point being time to recurrence. Secondary end points included intraoperative and perioperative complication rates, lengths of hospital stay, and 30-day as well as long term overall and disease free survival. The COST trial also addressed the adequacy of oncologic resection between groups as well as overall and disease free survival. The most significant conclusion from this study was a similar 3 year rate of recurrence and overall survival between laparoscopically assisted and open groups (16 % and 18 %, respectively). Additionally, surgical wound recurrence was less than 1 % in both groups and the rates of complications, 30-day mortality, readmissions, reoperations were all similar between groups while length of hospital stay and requirement for oral analgesics was less in the laparoscopic group compared to the open group.