Advances in laparoscopic renal and ureteral surgery.

With the introduction of laparoscopy into adult urology, a vast new field has suddenly opened itself up to the urologic surgeon, filled with exciting and promising possibilities of applying the principles of minimally invasive surgery to an ever increasing number of diseases that so far have only been approachable by incisional surgery. While undoubtedly, laparoscopy has been providing unprecedented challenges to the principles of open surgery, it is of paramount importance to critically evaluate each new laparoscopic procedure against its open surgical counterpart. However, despite a widely publicized higher complication rate for laparoscopic procedures, it must not be overlooked that each laparoscopist must go through his/her very own individual learning curve; although a painful process at times, it is not any different than the novice's introduction to open incisional surgery. The problems of the learning curve can be partly alleviated by carefully studying the basic principles of laparoscopy in the animal laboratory, and by subsequent clinical training under the guidance of an experienced laparoscopist. The discoverer's enthusiasm for his or her own newly developed procedure and the instinctive negative reaction of the practicing community to new concepts that threaten to overturn what is perceived as 'tried and true', must both be tempered by the accumulation of clinical data, testing the validity of all procedures, new and old alike. To this end, surgeons have the opportunity to explore a gentler form of surgical practice, one in which the practitioner can heal without the need to harm.