Endoscopic surgery: ideal for endocrine surgery?

The laparoscopic approach of endocrine tumors is recent, the first reported resection of an adrenal gland in 1992. It represents a revolution in endocrine surgery equivalent to that observed in general surgery after the first cholecystectomy was performed in 1987. This new approach needs evaluation in terms of feasibility, indications, safety, and surgical procedure to define its potential advantages. The surgical technique and operative approaches of laparoscopic adrenalectomies are at the present time well defined and mostly accepted. Pancreatic approaches and resections, thyroidectomies, and parathyroidectomies are more confidential and performed only by rare teams. Nevertheless, the development of this technique is ineluctable. The spread of this technique, partly due to the increased quality of the technologies available, especially cameras, encounter a major brake that limits its generalization: If general surgeons commonly perform laparoscopy in their daily practice, they treat few patients presenting endocrine disorders. On the other hand, endocrine surgeons to whom many patients are referred do not have regular videoscopic practice. Endocrine surgery benefit few patients for these reasons. An analysis of the present state of the art allows us to imagine the evolution and future of videoscopic endocrine surgery.