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The Author(s) 2009. This article is published with open access at Springerlink.com Endoscopic surgery is known for its different eye–hand coordination and its learning curves. It encompasses complex and sensitive equipment that requires different maintenance and quality control. Despite the development of dedicated training programs and extensive research justifying the endoscopic revolution, the Dutch Health Care Inspectorate (DHI) [1] recently surprised endoscopic surgeons with its report entitled Risks of Minimally Invasive Surgery Underestimated [2]. In this report, the Inspectorate expressed its sincere concern regarding endoscopic surgery in The Netherlands. The DHI report was based on investigations done by the Inspectorate initiated by unusual observations of incidents associated with endoscopic surgery. The investigations consisted of questionnaires and on-site visits to hospitals and endoscopic surgeons. Such activity is part of DHI’s task to control the quality of health care in general.

Risks of minimally invasive surgery underestimated: a report of the Dutch Health Care Inspectorate