If an optimized inflammatory and immune response can be expected with minimally invasive surgery, gastrointestinal tract procedures, with their greater effects on recovery, can be expected to show some of the greatest benefits from laparoscopic alternatives. This can be seen with intestinal resections for benign disease. Improved recovery, as measured by analgesic requirements and return to normal function, is noted after laparoscopic and laparoscopic-assisted colectomies.24,25 The microsurgical techniques of endoscopic resections have also improved access to higher rectal lesions, allowing local excision and avoidance of stomas.26 The advisability of laparoscopic resections for cancer of the gastrointestinal tract remains controversial. Studies have shown similar specimen pathological characteristics, comparable morbidity and mortality, and enhanced recovery, even in a debilitated population with metastatic disease.25,27,28 Concerns have arisen with reports of port site metastases, indicating that questions remain about the mechanisms of dissemination of malignant cells with laparoscopy.24,29- 31 Studies are currently being done to determine if aerosolization of cells, enhanced growth in a carbon dioxide environment, or shedding of cells on retrieval of the specimen are significant factors, and whether a laparoscopic colon resection for malignant neoplasms yields acceptable long-term results. It is possible that alternative methods of access, such as helium or air insufflation and gasless laparoscopy, may retain the benefits of recovery and immunocompetence while minimizing recurrence rates.32,33 While there are indications for laparoscopy in malignant neoplasms, for staging purposes and for avoiding laparotomy in advanced disease, the role of laparoscopic resection of the colon is awaiting the results of current prospective randomized trials and, for this indication at least, minimally invasive surgery is not yet the gold standard.