**1.2 Development of mini-lap (small-incision) cholecystectomy**

Minilaparotomy was used for several decades for the diagnosis of obstructive jaundice. Through a small incision is valued, in addition to the aetiology, the operability by palpation of the gallbladder and hilum liver and usually the diagnosis included a cholecistocholangiography.

In 1982 F. Dubois and B. Berthelot (Dubois & Berthelot, 1982) published the first paper on the minilaparotomy for operations on the bile duct, performing the procedure in 1500 patients, including alongside cholecystectomy, some cases of choledochotomy, sphincterotomy and choledochoduodenostomy. All these interventions were carried out with a transverse or oblique skin incision 3 to 6 cm in length, but the duration of surgery, the authors say, was "twice that of a normal operation". Intervention was carried out with the help of an autostatic (if no more than one assistant was available), a vaginal valve for retraction of the liver, a malleable valve for retraction of the hepatic flexure of the colon and the positioning of two packs for the separation of the colon and stomach, referenced with a tape.

The description of the intervention with this procedure and its duration arise a suspicion of some difficulty with exposure of the structures and the easement of the procedure. However, the authors describe: a minimization of cosmetic damage, solidness of the wall closure an a reduction of pain and postoperative ileus.

Moss, in 1983, published the first cases of cholecystectomy with stay less than 24 hours, and in 1986, 100 cases. Later, he operates 160 patients by midline laparotomy, with an incision that "barely allows the surgeon's hand", which were discharged the day after surgery without receiving narcotics, tolerating food intake between 8 and 18 hours and only 3 readmissions. The author concluded in 1996 that the benefits of laparoscopy may be more related to the enthusiasm and expectations for the new technology that in the technique by itself (Moss, 1996).

In 1985, Morton (Morton, 1985) performs a cost containment study of cholecystectomy with intraoperative cholangiography in 96 patients through an incision of 4 to 5 cm with a mean operating time of 45 minutes. The average stay was 2.5 days and analgesic requirements were lower than in the classical subcostal incision. The period of sick leave decreased significantly.

Goco and Chambers in 1988 (Goco & Chambers, 1988) studied the impact of minicholecystectomy in the management of health expenditure, considering the reduction of hospital costs compared to traditional cholecystectomy. The authors conclude, by analyzing 450 interventions, that a 4-cm incision produces an average stay of 1.22 days and that the savings stay was 4.78 days per case. Rating the daily cost at \$ 200 USA in 1988, it is easy to see the savings produced by minilaparotomy, especially if applied to the 600,000 cholecystectomies performed annually in the United States.

Despite these and further studies, minilaparotomy was never popular. For example, out of seven standard textbooks: Norton al al., (Harris, 2008). Sabiston (Arendt & Pitt, 2004), Schwartz (Schwatz 1989), Doherty (Doherty, 2010), Maingot (Karam & Roslyn, 1997), Marlow & Sherlock (Dawnson, 1985). Morris & Malt (Britton & Bickerstaff, 1994), only the latter describes the technique of cholecystectomy by minilaparotomy.
