Initial development of “minimal access surgery” began in the animal laboratory and was later studied in selected academic centers. It was imported to the community hospitals only when its benefits and safety were established. The development of laparoscopic cholecystectomy was not designed to enhance the safety of the procedure, but rather to reduce the discomfort associated with the surgical incision. The fierce economical competition in medicine fueled by the managed care movement led to the rapid adoption of laparoscopic surgery among surgeons and gynecologist in community hospitals who were not formally trained in this technique and acquired their knowledge by subscribing to short courses. Low complication rates were reported by centers specializing in laparoscopic surgery, mostly in academic centers. These centers were able to reduce the complication rate to minimum by developing proficiency in this surgery. Regrettably, many inexperienced surgeons perform this te
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