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Assuring quality in an age of rapid technological advance

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Can today’s quest for innovation and efficiency in health care learn from the development of the laparascope?

The first series of over 100 patients in whom laparoscopic examination of the abdominal cavity was conducted safely was reported in 1910 by the Swedish surgeon Hans-Christian Jacobaeus,1,2 although, another surgeon, Georg Kelling of Dresden, subsequently claimed, somewhat miffed, that he pioneered the procedure in two patients in 1902 using a cystoscope.3

However, it was not until the 1930s that laparoscopy was used to support diagnostic biopsy. John Ruddock, a Californian cardiologist who became fascinated with the technique, reported hundreds of cases in which laparoscopy enabled high levels of diagnostic accuracy for hepatic and gastrointestinal disorders.4

Things were then quiet on the laparoscopic front until the introduction, in 1982, of a computer-chip camera into the laparoscope that revolutionised its use by projecting visual information, previously perceived only through one eye atop the laparoscope tube, onto a television screen in the operating theatre.

First in France in 1988, then in the rest of Europe and on into the United States, laparoscopic cholecystectomy became a frequent procedure. The spread of laparoscopic cholecystectomy…