[Laparoscopic technique--which developments are possible?].
The progress of laparoscopy is influenced by both the medical and technical aspects. The development of endoscopes and various rigid instruments has increased the indication options. Nevertheless, several drawbacks remain, e.g. the limited spatial view, the missing sense of touch, and reduced mobility in the operation area. New 3D visual systems now introduce spatial view. Flexible instruments are being developed that allow thorough examination of organs. While these enhancements are now becoming available, research and development are making progress and preparing the next steps. One vision is the development of a telepresence and telemanipulation system. With it, at the patient's side we will have an endoscope guidance system and several instrument guidance systems, which will be telemanipulated from a control station. At the control station, a 3D picture from the operation scene, together with virtual reality simulation pictures will be available. Force reflection as well as palpatory sensing information will be readily available to the telesurgeon. These new developments will improve the quality of the surgery for the benefit of both the patient and surgeon. Furthermore, the training of new surgeons will be eased by the use of sophisticated simulators using virtual reality techniques. These and further technical developments will not only lead to an improvement in current laparoscopy procedures, but it can be expected that additional procedures will be developed that are not yet possible and accessible to laparoscopy.