In fairness, it is worth noting that open appendectomy is no longer the major invasive technique it once was, and can now be performed by making a small, muscle splitting incision.

David Lomax, a surgeon from Perth, Australia, believes the argument should pivot more on the type of operation for which laparoscopic surgery is appropriate. It may well become the procedure favoured for operations such as cholecystectomy, but inappropriate for appendectomy and cancer. "Unfortunately, in getting to this stage, many patients will have had complications resulting from this minimally invasive surgery. There are all too many intensive care specialists who know of several admissions to their units necessitated by those complications," he writes in The Lancet (13 November 1993).

Clearly, further research is needed, particularly into the benefits of laparoscopy for other diseases, such as gall bladder problems. The difficulty in assessing any surgical procedure against another by randomized trial is finding surgeons of similar training and experience and patients with a similar medical history and profile. The other problem is the lack of funding to finance the research.

Whereas most clinical trials are funded by the drugs companies, there is no obvious commercial benefactor of a successful trial except the equipment manufacturers.