Abstract
Minimally invasive surgery (MIS) has revolutionized the management of surgical disorders in a very short period of time. It has moved the focus of surgery towards reducing the morbidity without compromising on the quality of healthcare. After conceiving the idea of this novel surgical approach by a German surgeon, George Kelling in 1901, it took almost a century to leap forward to the therapeutic stage when laparoscopic cholecystectomy (LC) was performed first by two French surgeons, Phillipe Mouret in 1987 followed by Dubois in 1988.1

Thanks to the advent of new instruments, LC rapidly replaced open cholecystectomy as a procedure of choice.2 The initial period of enthusiasm for this novel procedure was followed by an era of concern characterized by increasing rate of reported complications in different surgical procedures. Studies showed that the laparoscopic approach posed a problem of much greater complexity than open access, requiring more sophisticated instrumental armamentarium.3 Inspite of these concerns, LC had a shorter hospital stay, decreased post-operative pain and early return to work and daily life.4,5 Despite these promising results LC was still regarded as a challenge for those who had zeal for this field of surgery.6 With availability of improved instruments and refining of techniques, laparoscopic approach has expanded its applications from comparatively simple procedures such as cholecystectomy and appendectomy to major intra abdominal, urological a number of gynecologic procedures7 with list growing day by day.

Recent technological advances like the application of ultrasonic dissection8 and procedures involving natural orifices, the so-called Natural Orifice Trans luminal Endoscopic Surgery (NOTES), 9 may result in a quantum leap in current surgical practice. A surgical robotics system has further revolutionized the minimally invasive surgical techniques.10 Considering the current pace of developments and innovations it is beyond ones imagination how the surgical procedure will be performed ten years from now.

Despite the fact that minimally invasive surgical techniques are gaining widespread acceptance and applause, the reports of its adverse sequels continue to swell as well. Bile duct injury has been well known in this regard.6 Port site metastasis, port site hernia and even death have been reported.11 It could not be over emphasized that adequate training of surgeons undertaking laparoscopic procedures needs to be ensured and necessary certification to be done by the competent professional bodies before the surgeons are allowed to embark on such procedures.12

While MIS is now a well established reality all over the world and many universities across the globe have established centers of excellence for the simulated as well as hands on training of surgical trainees at these institutions, it is sad to state that there are only a handful of centers in Pakistan where proper facilities for training surgeons

Key words: Minimally invasive surgery, Laporoscopic cholecystectomy