In 1902, Georg Kelling (Dresden, Saxony) performed the first laparoscopic procedure in dogs, and in 1910, Hans Christian Jacobaeus (Sweden) reported the first laparoscopic operation in humans. In the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The introduction of computer chip television camera was a seminal event in the field of laparoscopy. The first publication on diagnostic laparoscopy by Raoul Palmer, appeared in the early 1950s, followed by the publication of Frangenheim and Semm. Hans Lindermann and Kurt Semm practised CO₂ hysteroscopy during the mid-seventies. In 1981, Semm, from the Universitats Frauenklinik, Kiel, Germany, performed the first laparoscopic appendectomy. Following his lecture on laparoscopic appendectomy, the president of the German Surgical Society wrote to the Board of Directors of the German Gynecological Society suggesting suspension of Semm from medical practice. Subsequently, Semm submitted a paper on laparoscopic appendectomy to the American Journal of Obstetrics and Gynecology, which was rejected as unacceptable for publication on the ground that the technique reported on was “unethical”. His paper was finally published in the Journal of Endoscopy. Prior to 1990, the only specialty performing laparoscopy on a widespread basis was gynecology, mostly for relatively short, simple procedures. Laparoscopy in general surgery began in 1985 with the first laparoscopic cholecystectomy performed by Erich Muhe and submitted to the Congress of the German Society of Surgery. The following year, Mouret presented the clip of his procedure at Dubois in Paris [1] and only afterwards it was also performed in the United States [2]. As result of these first experiences, laparoscopy spread widely—thanks to the innovation in the technological field too. This condition led to the application of the new approach to other surgical procedures, such as gastrointestinal and bariatric surgery, with variable success depending on the technique. In fact, 38 years after the first bariatric procedure, which was a jejuno-ileal bypass, performed to treat morbid obesity by Kremen in 1954 [3], Broadbent [4] and Catona [5], who placed a nonadjustable gastric band, performed the first laparoscopic bariatric surgery in 1992–1993. Belachew et al. and Forsell et al. were the first to perform a laparoscopic adjustable gastric banding. These laparoscopic roots of bariatric banding may explain the early prevalence of laparoscopic adjustable gastric banding in Europe. In 1994, Wittgrove et al. performed the first laparoscopic gastric bypass in the United States, initiating preference for laparoscopic gastric bypass that has come to dominate the country’s operative selection in the first decade of the twenty-first century. Also in 1994, Hess performed a laparoscopic vertical banded gastroplasty. In 1991, the National Institutes of Health Conference statement on gastrointestinal surgery for severe obesity stated that bariatric surgery is the only therapy which let the morbid obese patients to reach a stable and satisfactory weight loss [6]. Hence, bariatric surgery, which had a great expansion in the middle of 1900s, reached higher levels with the introduction of laparoscopy because it was proved to be safe and feasible. Nowadays, laparoscopy is considered the “gold standard” for the surgical treatment of morbid obesity. Many different types of operations can be performed: vertical banded gastroplasty (VBG), adjustable gastric banding (AGB), laparoscopic Roux-en-Y Gatric bypass (LRYGB), sleeve gastrectomy (SG), and biliopancreatic diversion (BPD). LRYGB is the procedure mostly performed [7]. It is demonstrated that a team of bariatric surgery recently built up is associated with a doubled or tripled complications rate due to the learning curve. In fact, the LRYGB is a challenging procedure because of visceral fat, liver size, and thickness of the abdominal wall. For this reason, the surgeon must be technically proficient. Some authors believe that a total number of procedures ranging from 75 to 120 are necessary to obtain a postoperative complications rate similar to that reported in literature. The American Society for Metabolic and Bariatric Surgery (ASMBS) asserts that to be a proficient surgeon it is needed to certify 100 bariatric procedures, whose half as first operator, with a good outcome, starting from the residency supervised by an experienced surgeon. This kind of skills standardization is not well established in the European countries where the achievement of such a training program is more difficult [8]. The difficulty for the training resident to perform LRYGB comes from the required advanced laparoscopic skills. To solve this limitation, a new training curriculum comprising five steps has been proposed:

An evolution of laparoscopy is the application of a single-incision laparoscopy (SIL) in bariatric surgery. Several authors have reported their own experience showing that it is a feasible technique in groups of highly selected patients. The selection is based on the type of intervention which should be not complex and on body habitus. Patients with tall trunk are more difficult because of the distance between the epigastric zone and ombelicus that should be not more than 22–25 cm. The potential advantages include less postoperative pain, better cosmetic result, and satisfaction of the patient. Some authors report an increase of incisional hernia rate due to the longer fascial incision. Furthermore, these patients often undergo plastic surgery after the achievement and maintenance of ideal weight whereby the desired esthetic result is reached in a second phase [9].

The further innovation in the minimally invasive surgical techniques development led to the application of the robot in bariatric surgery, trying to overcome the limits of standard laparoscopy. The robotic approach is safe and feasible in all types of bariatric surgery with a postoperative complications rate, including anastomotic leakage, very low and only slightly different from the conventional laparoscopy [10]. Robotic bariatric surgery has a shorter learning curve; in fact, it is believed that 20 cases are enough to overcome the basic learning phase. The robot could be useful in patients with difficult anatomy or in cases of revisional surgery after restrictive procedures where the surgeon may find difficult dissection and reconstruction. At present time, there is no scientific evidence about the superiority of the robot-assisted technique on the conventional laparoscopy whereby the exact role of the robotic approach should be defined more precisely in larger studies, also evaluating the high costs [10, 11].