The rapid development of technology facilitating minimally invasive surgery has challenged the surgical community to evaluate the safety and efficacy of these new techniques even as they were being widely utilized. The publication of retrospective series in a few institutions was followed by widespread adoption of laparoscopic cholecystectomy and subsequent reports of increased complications from the procedure. Other laparoscopic procedures such as antireflux operations and colectomy for cancer require greater technical skill and hold potential for significant morbidity. Because a prospective, randomized clinical trial is unlikely for these procedures, other measures of results need to be examined. A state registry is one such outcome study to be considered. In the state of Oregon we designed and implemented a voluntary registry program for these advanced procedures. Although the antireflux procedures are apparently being done safely, conclusions that can be drawn from such a registry are limited because of incomplete data collection. For a registry to be maximally effective, an automatic method of data accumulation is needed that will capture all cases that are done as well as follow-up information.
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