Retroperitoneal growths often require surgical exploration for diagnostic and/or therapeutic purposes. Here in, we present our experience in laparoscopic management of retroperitoneal masses and review the literature to assess the feasibility of a minimally invasive approach in this setting.

In the last 4 years 8 consecutive patients, aged 46 to 73 years, underwent laparoscopic surgery for isolated retroperitoneal masses at our institution. Medical records were reviewed collecting data regarding clinical presentation, dimensions of the finding, pathology, whether a preoperative biopsy was performed and its results, procedure performed (excision versus incisional biopsy), operative times, est

All procedures were successfully completed laparoscopically with no conversions. Mean operative time was 131 minutes. Blood loss was 0-200 mL and blood transfusions were not required. One bowel injury was repaired intraoperatively; postoperative course was uneventful in all cases. Hospital stay ranged from 2 to 7 days. Final pathology was local recurrence of Renal cell carcinoma in 3 cases, 1 lymphoma, 1 sarcoma, 1 schwannoma and 2 retroperitoneal cysts. With an average follow-up of over 2 years there are no recurrences.

Laparoscopic approach is a feasible approach in selected patients with retroperitoneal masses. In our experience, laparoscopy offers a viable and oncologically radical option with excellent results and low morbidity. This minimally invasive approach is likely to become more common practice as the experience grows and new technologies become available.

To assess the feasibility and effectiveness of transperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. Laparoscopic pyeloplasty has been shown to have a success rate comparable to that of the open surgical approach. We report the results of our first 15 cases of transperitoneal dismembered pyeloplasty.

From August 2006 to September 2007, 15 patients underwent laparoscopic transperitoneal pyeloplasty for ureteropelvic junction obstruction. All patients underwent dismembered pyeloplasty. All patients were followed with diuretic renography (DTPA renal scan) at 3 months and 1year of follow-up and intravenous urography at 1 year follow-up to assess the success of the surgery.

Fourteen of the fifteen procedures were successfully completed. The procedure was converted to open surgery in one patient who had history of recurrent UTI and friable tissues which were not holding the sutures. Crossing vessels were identified in 7 out of 15 patients(46.7%) which required transposition of the ureter and pelvis before anastomosis. Four patients had associated calculus disease and in 3 out of 4 patients the calculus was removed. Average operating time was 3.75 hours (range 3 to 5 hours) and the mean blood loss was 150 ml. Mean hospital stay was 5.5 days. Mean duration of analgesic use was 5.2 days. Postoperative complications included urinary peritonitis in one patient and suture granuloma in 2 patients. 14 out of 15 patients(93.33%) showed definite improvement in renal function and drainage on radiographic evaluation.

Laparoscopic pyeloplasty (LP) is a safe and effective minimally invasive treatment option that duplicates the principles and techniques of definitive open surgical repair. The success rates associated with LP are comparable to those of the gold standard, open pyeloplasty.

Appendicectomy is a commonly performed surgical procedure. Conventional open appendicectomy is sometimes met with difficulties, particularly when the appendix is malpositioned, in obese patients and patients having peritonitis. On the other hand, laparoscopic appendicectomy conferring several advantages over the open technique is time consuming and requires complex maneuvers like intra and extracorporeal knotting. Understanding the advantages and disadvantages of the above two techniques, we have been using a combination of both which we will be terming as ‘Hand Assisted Laparoscopic Appendicectomy (HALA)’.

83 cases were subjected to appendicectomy using the mentioned technique both for acute and recurrent cases. Patients having gangrenous appendicitis or with necrotic and friable appendix were excluded from the study.

The results are as follows:

1. Duration of hospital stay: 2.4 days

2. Wound infection: 5/83

3. Duration of follow-up: till 1 month postoperative.

4. Paralytic ileus: 3/83

5. Operating time (mean): 30 minutes.

Hand assisted laparoscopic appendicectomy (HALA) is a safe alternative technique providing all advantages of minimal access surgery while reducing the complexities associated with it.

The advent of laparoscopic surgery raises the question of what to do with a normal appendix at laparoscopy for right iliac fossa pain of uncertain origin. We assess the views of all members of the Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) via means of a survey. Of 135 responses to the questionnaire 61% of surgeons remove a macroscopically normal appendix and 26% do not. 13% of surgeons do not commit. Of those removing a normal appendix the most common reasons given were the possibility of endoluminal appendicitis (87%) and avoiding future confusion as to whether the appendix had been removed (64%). When asked whether there were sufficient guidelines on this topic 68% said no, 6% said yes and 5% were unsure. 16% said that it was a matter for common sense rather than guidelines and 5% felt that the evidence was contradictory. This study highlights a lack of consensus in the management of a normal appendix found at laparoscopy for right iliac fossa pain and demonstrates most surgeons feel guidelines would be useful. In the absence of guidelines the options may be discussed with the patient before operation.

Though laparoscopic salpingotomy is the preferred conservative surgery of choice in patients desirous of future fertility, the management of ectopic pregnancy has changed extensively. Other modalities like medical management with Methotrexate are being reviewed for conservative management of tubal pregnancy.

To compare intratubal Methotrexate instillation with laparoscopic salpingotomy for conservative management of tubal pregnancy.

A literature review was conducted using search engines Google, Highwire press. Success rate after treatment and future reproductive outcome were analyzed.

Laparoscopic salpingotomy was more superior to with Methotrexate as conservative treatment of ectopic pregnancy.

Wide variations are reported in morbidity, mortality and conversion rates for laparoscopic cholecystectomy in the octogenarian population. As a retrospective review, this paper reports the experience of a district general hospital unit in the management of gallstone disease in an elderly population.

The case notes of all patients over 80 years of age undergoing laparoscopic cholecystectomy over a 7 years period were retrospectively analyzed. Primary outcome measures were conversion to an open procedure and complications of surgery.

Sixty-eight octogenarians (mean age of 84 years [range 80- 96 years], 37 female) undergoing laparoscopic cholecystectomy were identified. Five (7.3%) operations were converted to open surgery.

The total number of patients having complications was 16 (24%), 8 (12%) being grade 1 and 8 (12%) grade 2. Forty-eight (71%) patients had complicated gallstone disease. Grade 2 complications were related to the presence of CBD stones (p = 0.0003).

Octogenarians should be considered for laparoscopic cholecystectomy for symptomatic gallstones. Although the overall risk of complications remains higher in octogenarians, conversion rates can be low. Octogenarians with common bile duct stones may be best managed with ERCP as this group of patients appears to be at particular risk from surgical intervention.

Hysteroscopy is a valuable tool in the evaluation and treatment of infertility and many other gynecological procedures. Its use has relegated blind procedures for the investigation and treatment of endometrial pathologies and in some instances obviates the need for open surgeries. Unfortunately the equipment is only available in a few private hospitals in Nigeria.

To describe our experience with hysteroscopy in a private hospital setting in Nigeria.

Retrospective reviews of all cases of hysteroscopy done between January 2003 and December 2005 at Nisa Premier Hospital (Nordica Fertility Centre), a dedicated fertility center in Abuja, Nigeria was carried out. Relevant information was extracted from the patients’ case notes and theater records. The hysteroscopic procedures were carried out during the proliferative phase of the patients’ menstrual cycle. All but nine patients had paracervical block with xylocaine in addition to intravenous pentazocine and promethazine for pain relieve. Normal saline was used as distention medium.

A total of 87 hysteroscopies were carried out during the period under review. Eighty-five patients (97.7%) presented with infertility. Forty four patients (48.3%) had single pathology while 23 (26.4%) had multiple pathologies. The commonest pathology was intrauterine adhesions (64.2%). There were 3 cases (3.5%) of retained fetal bones within the endometrial cavity. Sixty-four (73.6%) patients underwent hysteroscopic surgical procedures. The commonest surgical procedure performed was intrauterine adhesiolysis (67.2%), followed by polypectomy (35.9%). One complication occurred during the study period (anesthetic).

Hysteroscopy is a valuable tool in the assessment of the uterine cavity. The equipments and skills are however presently lacking in Nigeria.

Chronic pelvic pain is a common and significant disorder of women.

Often the etiology of chronic pelvic pain is not clear.

Chronic pelvic pain is a common problem and presents a major challenge to health care providers because of its unclear etiology, complex natural history, and poor response to therapy. Diagnostic laparoscopy is an important tool in the evaluation of women with chronic pelvic pain.

Uterine myoma commonly referred to as fibroids, are so far the commonest benign tumors of the female genital tract and are the commonest soft tissue tumors of all. Worldwide, several thousand patients suffer yearly and some undergo surgery as a result of symptoms and complications of fibroids. Myomectomy, the removal of fibroids has always been done by laparotomy but recently, laparoscopic myomectomy has been started and is really getting support from endoscopic surgeons. Laparoscopic myomectomy, a heterogenous procedure, ranges from a simple procedure to a more complex one requiring expert laparoscopic suturing skills. Large pedunculated myomas are easily removed laparoscopically, but intramural ones really pause a challenge for these surgeons. Several studies have been conducted mainly nonblind ones and the results, though encouraging, do not look scientifically convincing. Laparoscopic myomectomy has its advantages but as is any new mode of treatment or surgery, it has its opponents and proponents.

The few double blind studies done have good convincing conclusions but more really needs to be done. The biggest challenge in laparoscopic surgery in general, is the cost of the equipment and therefore the cost of surgery.

When this study was undertaken, initially it was thought no data would be obtained, but by the time of completion of the study, there was enough data collected. Only that, different investigators, looked at different issues differently. It was concluded that more research work needs to be done so that we may have more convincing, well researched issues to lay the fears of the doubting at rest.

To evaluate the benefits of laparoscopic procedures for pancreatic psudocyst over open surgery based on these parameters:

a. Selection of patient

b. Time and technique of surgery

c. Postoperative pain and use of analgesics

d. Recovery and hospital stay

e. Complications

f. Quality of life

g. Cost effectiveness

abdomen is the “Black box” i.e., it is impossible to know what specific injuries have occurred at initial evaluation. The key to saving lives in abdominal trauma is NOT to make an accurate diagnosis, but rather to recognize that there is an abdominal injury. Minimal-access surgery is an integral component of the alternative surgery management paradigm. The addition of videoscopic technology to intracavitary endoscopy has led to a tremendous expansion of indications for minimal-access procedures in all fields of surgery. The use of laparoscopy to assess the peritoneal cavity for injury is not a new concept. Reports by Tostivint et al, Gazzaniga et al, and Carnevale et al discussed the possibilities of using this minimally invasive approach to evaluate the peritoneal cavity for injuries. Laparoscopy has become an important diagnostic and therapeutic tool in the treatment of both blunt and penetrating traumatic injuries. Laparoscopy has been shown to be valuable in detecting occult diaphragmatic injuries in locations where computed tomography (CT) scanning and diagnostic peritoneal lavage have recognized limitations. Notably, laparoscopy can also provide therapeutic interventions in certain circumstances as well. Simultaneous gastric and diaphragmatic injuries have been repaired using this approach. Laparoscopy has been used to repair blunt traumatic solid organ injuries, including a subcapsular splenic hematoma. Blunt hepatic injuries have been successfully treated laparoscopically with the instillation of fibrin glue. A duodenal hematoma has been decompressed laparoscopically. Importantly, in trauma patients with potential intracranial injuries, laparoscopy should be used cautiously because of the risk of increased intracranial pressure. Laparoscopy is also potentially hazardous in patients with acute respiratory distress syndrome, because lung compliance and effective gas exchange may be further decreased by the pneumoperitoneum. Laparoscopy can be performed safely and effectively in stable patients with abdominal trauma. The most important advantages are reduction of morbidity, shortening of hospitalization and cost effectiveness. In the future, new development in laparoscopy equipment and the introduction of computer technology and robotic devices can be expected to have a decisive influence on the treatment of trauma patients.

Standard diagnostic laparoscopy is considered the gold standard to investigate pelvic pathologies (tubal pathology, endometriosis, and adhesions...). It gives a panoramic view of the pelvis. But the invasiveness of diagnostic laparoscopy has almost eliminated its pure diagnostic role from contemporary management of common pelvic pathologies. It consequently appears interesting to propose an endoscopy diagnostic procedure as powerful as the laparoscopy but less invasive which doesn't require general anesthesia and full operative facilities. This is the case of transvaginal hydrolaparoscopy (THL) which proved its efficiency while being as precise as standard diagnosis laparoscopy.

Uterine fibroids (also known as myomas or leiomyomas) are the commonest benign solid tumours found in the female genital tract. Hysteroscopic myomectomy presently represents the standard minimally invasive surgical procedure for treating submucous fibroids. Whether treatment with GnRH agonist before hysteroscopic myomectomy offers significant advantages is still a matter of debate.

A literature search was performed using Medline and the Google search engine, Springerlink and Highwire Press. A total of 11 articles were selected for review.

GnRH agonist use prior to hysteroscopic myomectomy probably has potential benefits in terms of reduction in size of the fibroid and improvement of hemoglobin level, especially in patients with underlying secondary anemia. However, universally acceptable guidelines on the indications and duration of pretreatment whether administered monthly or as daily injections are lacking. Large randomized controlled trials are urgently needed to clarify the gray areas.