They suggest that the higher rates may reflect a broadening of accepted indications for surgery and an overreadiness on the part of surgeons to press ahead for the operation. Unlike open surgery, laparoscopic gallbladder surgery is conducted using a laparoscope, which is inserted through a small incision. The surgeon performs surgery via a view of the organs on a videoscreen. 'Patients who previously were felt to have minimal or questionable symptoms attributable to gallstones may now be offered the new technology because of its presumed lesser morbidity,' they say.

In other words, because the new technique is thought by surgeons to be less risky, they are carrying it out on patients who probably don't need it. The researchers also point out that the doctors have taken up this technique with such enthusiasm before 'any formal evaluation of its benefits and risks by academic centers.'- JAMA, 22-29 September 1993.

Meanwhile, another study suggests that laparoscopic surgery may not bring many of the benefits supposedly associated with it.

Researchers in Hong Kong concluded that those having their appendix removed by laparoscopic or conventional surgery had 'no significant differences postoperatively for pain score, analgesic requirement, time to reintroduction of diet or hospital stay.' The main difference they found was a longer operating time for those having laparoscopic surgery.- The Lancet, 11 September 1993.