In Taiwan, the first case of laparoscopic colon resection was performed in May, 1993 for chronic cecal diverticulitis；in December of the same year, the first case of laparoscopic resection of colon cancer was done for a T2N0M0 stage sigmoid cancer. At that time, the cost-effectiveness of this novel surgical technique was low and the efficacy of laparoscopic approach for colorectal cancer was still unknown. Beleaguered by these multiple unfavorable factors, the Taiwanese colorectal surgeons performed only a very limited number of benign colorectal lesions, let alone doing laparoscopic surgery for malignancies. However, three or four aspiring colorectal surgeons still toiled over this new surgical technology through porcine or canine model to master the basic dissection, stapling, and anastomosis skills, and even the laparoscopic property. During this period, to learn and to perform laparoscopic colorectal surgery are both very struggling.

　　It was not until the emergence of Harmonic Scalpel in 1997 that provided efficient laparoscopic dissection over anatomical boundaries such as omentum, mesentery, and even retroperitoneal areolar tissues, and the introduction of medial-to-lateral laparoscopic no-touch isolation technique, the fledgling laparoscopic colorectal surgeons were greatly encouraged to perform this novel technique. Simultaneously, between 1997 and 2000, due to the surgical endeavor of a handful of pioneer surgeons in “center of excellence” all over the world, the case number of laparoscopic resection for colorectal malignancies increased significantly in Taiwan. In 2000, we commence the annual training workshop of laparoscopic technique for colorectal surgeons. Until 2003, more than 500 cases of laparoscopic resection were performed in National Taiwan University Hospital. From then on, the laparoscopic skill was reckoned as mature, and actually the approaches were widely applied to all the colorectal diseases that previously were treated by traditional open surgery, yet a randomized trial regarding laparoscopic approach for rectal cancer was still lack of. Currently, laparoscopic resection of colorectal cancer represented around 80 per cent of the personal series in National Taiwan University Hospital, as compared to approximately 10 per cent of all cases of colorectal cancer in Taiwan.

　　Based on the experience from developmental stage, we feel that the best way to penetrate laparoscopic colorectal surgery is to observe on field and even work together with well-experienced surgeons. Although the pioneer surgeons mastered laparoscopic skill through the dissection of fresh cadaver, we feel that it was unnecessary for the beginners. However, basic skill training on porcine or canine model was still necessary. In our institution, minimal invasive training center was established since 2005. Furthermore, the efficient exposure and dissection are based on laparoscopic view of the subtlety of anatomic structures. There are several unique anatomic concepts such as the definition of mesenteric root of distal transverse colon, surgical implications of Gerota fascia, Denonvilliers’ fascia, and so on should be re-scrutinized to facilitate a precise laparoscopic dissection.
The possibilities for using minimal invasive technologies to improve the outcome of patients undergoing colon and rectal surgery will be enormous in the next decade. In our view, the colon and rectal specialist may possess unique skills that put her in an enviable position for a futuristic approach to the minimal invasive procedure. To facilitate the efficiency of the laparoscopic colorectal surgery and to accelerate and enhance the educational process, the equipments such as high-definition laparoscopic video cameras, better energy devices, and increasingly smaller devices incorporating sophisticated technology (single-port device, radius surgical system for suturing and tying in more degrees of freedom, Da Vinci system), and even the operating theater itself will be subjected to profound changes in the near future.