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To explore the cost-effectiveness of laparoscopic colorectal surgery over time since it was first developed in 1991. Several studies have confirmed that laparoscopic colorectal surgery (LCS) has superior short term outcomes when compared to open colorectal surgery (OCS). However, the evidence for cost effectiveness of LCS is less clearA systematic review of the literature from 1991 to 2009 using the keywords ‘laparoscopic - colorectal - surgery - cost - economic - evaluation’.Fifteen economic evaluations met the inclusion criteria. The percentage cost difference between OCS & LCS varied widely between different studies. The general trend demonstrated a moderate negative correlation betweenprogression of time and the size of the cost gap between LCS & OCS (R-value = -0.44). This correlation is even stronger (R-value = -0.64) if the studies are subdivided by the development of the country the surgery was carried out in; developed countries even though they had a heterogeneous set of results (SD = 27%) showed a decline in costs of LCS with time.From the current trends it isprojected that the results of future economic evaluations will unequivocally show that laparoscopic surgery is cheaper than open surgery.