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How much has the introduction of laparoscopic surgery changed open surgery?

During the last decade of the twentieth century there was a proliferation of laparoscopic surgical procedures. This has been credited with significantly improving the care and outcomes of surgical patients, despite the presence of little evidence to support such claims. Many laparoscopic procedures have developed due to the perception that they are better; however, this perception was not and is not supported by level one data (randomised controlled trial). It is hard to obtain level one data to validate the perception of advantage once a technique has become fully established. At the same time that laparoscopic surgery was developing, many other aspects of peri-operative care changed that influenced outcomes. These changes may account for many of the benefits claimed by laparoscopic surgery.