Emergency laparoscopy: a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients' comfort.

S practice is continuously evolving mainly because of technologic developments and better-performing instruments. Recent evolution of technology has dramatically changed the range of available instruments and, subsequently, the therapeutic options that can be offered to patients needing surgical interventions and eventually even emergency surgery. Laparoscopy is now well recognized worldwide as the criterion standard approach for cholecystectomies and gynecologic procedures. The minimally invasive approach, commonly termed keyhole surgery, refers to a surgical procedure performed through small abdominal incisions as small as those of a ‘‘door lock,’’ as opposed to the traditionally larger and more painful laparotomy incisions, therefore captivating the patient’s preference. The laparoscopic approach carries several significant advantages for patients, both in terms of much less postoperative pain (every effort should be undertaken to avoid or at least minimize pain)Vincluding faster and better postoperative recovery, shorter hospital stay, earlier discharge, and earlier return to normal daily activity, such as physical exercise (including sports and sexual life)Vand a significantly faster return towork. Therefore, these advantages might not only reduce the costs of the hospital stay for the health systems but also positively influence the social costs, allowing patients to resume their work significantly earlier and avoid long periods of inactivity. The protocols of ERAS [enhanced recovery after surgery program] have been best applied in conjunction with minimally invasive and laparoscopic procedures. In recent years, the use of laparoscopy became popular in colorectal surgery and surgical oncology. In this setting, while achieving good oncologic results and satisfying good oncologic quality criteria in terms of radical resections and number of lymph nodes removed, modern laparoscopy currently allows extended colectomies or wide and low rectal resections with total mesorectal excision without negatively affecting oncologic quality indicators such as perioperative morbidity, shortand long-term mortality, local recurrences rate, and tumor stageYrelated survival rate but rather improving the postoperative quality of life, reducing pain, and improving aesthetic results. Further technologic improvements include the development and refinement of laparoscopic techniques, the introduction of highly performing endoscopic staplers and endoscopic scissors using avariety ofmodern energies, and the enhancement of the laparoscopic suturing skills achieved by the new generation of ‘‘minimally invasive surgeons,’’ who made feasible gastrointestinal anastomoses by using totally intracorporeal techniques (seeVideo, Supplemental Digital Content [SDC] 1, http://links.lww.com/TA/A428) in a ‘‘scarless’’ fashion. The resected specimen is then extracted through dedicated miniincisions that can be made even smaller (if an intracorporeal anastomosis is performed [Fig. 1C andD; Fig. 2A and B]), less painful (if muscle-splitting rather than muscle-cutting methods are used), and extremely low and concealed (i.e., so-called mini-Pfannenstiel incision in suprapubic site, just below the ‘‘bikini’’ line or level of underwear and therefore less apparent [Fig. 2C and D]). Compared with oblique incisions in the right hypochondrium for right colectomy with eventual extracorporeal anastomosis, in the left iliac fossa for left colectomy, or with enlarged midline umbilical incisions, the suprapubic miniPfannenstiel incision to extract the surgical specimen has been shown to be associated with much a lower incidence of surgical site infections (SSIs). This kind of SSI often persists for several weeks, requiring repeated wound care, outpatient clinic appointments, delayed wound healing, and eventually even delay to the resumption of normal independent daily living, such as attending to personal hygiene and mobilizing. Furthermore, when associated with intracorporeal anastomosis, a suprapubic mini-incision of a few centimeters carries the risk of postoperative incisional hernia close to 0%, which is significantly lower when compared with oblique or midline incisions and hypochondrial or iliac incisions. The transverse muscle-preserving approach or muscle-splitting techniques PROCEDURES AND TECHNIQUES