Minimal Access Cancer Surgery (MACS) has a long learning curve. One has to be comfortable at open surgery before venturing into MACS. The selection of suitable patients for laparoscopy is an essential step to ensure satisfactory outcomes. Selection criteria should incorporate both patient and tumor characteristics. It should be based on surgeon’s experience, with easier cases attempted initially and more complicated cases at a later stage. By doing this one can minimize the problems of prolonged operative time, surgeon frustration and patient complications. Thin patients and early tumors with no previous surgery or radiotherapy or chemotherapy would be ideal to begin with.
Previous abdominal surgery also increases surgical difficulty. Surgical scarring can range from minor adhesions to a complete absence of intraperitoneal operating space. The entry technique needs to be modified according to the scar. A ventral or incisional hernia from previous surgery further complicates the decision making. Obesity make MACS difficult, though they are the major benefactors of this technique as the surgical morbidity is significantly lowered among them. Chemotherapy or radiotherapy given in-order-to downstage the disease could lead to fibrosis and thus difficulty in defining the planes of dissection.Each patient has to be carefully considered for MACS with the surgeons experience in mind.