Minimal access surgery has had resounding impact in the practice of surgery. The advantages include less scarring, quick recovery and return to work. It is not surprising that this field has received attention in the practice of fetal surgery as clinicians were faced with considerable complications inherent in open surgical procedures. The field has evolved, skills refined and technology improved, allowing management of selected fetal conditions through minimal access into the uterine cavity and the fetus. There is however, challenges that needs to be addressed. Open surgery cannot be relegated to history books at this stage and the two approaches have specific indications and are complementary.

To assess the outcomes of laparoscopic and open reversal of Hartmann's procedure.

Studies of laparoscopic reversal of Hartmann's procedure with comparison of open approache are searched from medical literature and outcomes of the approaches made.

Laparoscopic reversal of Hartmann's procedure with the advantages of smaller incisions, decreased postoperative pain, shorter recovery time, and early return to normal activity may reduce morbidity rates. And laparoscopic approach has a clear advantage over open approach for mobilization of the splenic flexure by avoiding an upper abdominal incision and its potentially increased respiratory complications when mobilization is mandotary. The most commonly reported reason for conversion to laparotomy was the failure to identify the rectal stump and conversion rate is between 4 to 22%. There are only two studies directly comparing laparoscopic and open reversal approaches, up-to-date.

Laparoscopic reversal of Hartmann's procedure for restoration of intestinal continuity can be performed with low morbidity and a short hospital stay.

To review about incisional hernia following laparoscopic abdominal surgery and the relationship between the pathogenesis and clinical features and manifestation of trocar site hernias.

We searched for this subject on Medline and Google search by combining all these words like “trocar,” “port,” “hernia, and “laparoscopy.”

We were not able to find a common factor that analyzed the factors related to trocar site hernia by multivariate analysis. Therefore, we could not indicate the only independent risk factor. However, we have referred to many reports that have logically indicated pathogenesis. The literature what we have gone through frequently point out that the main pathogenesis is not host factors but rather technical ones; besides, most accurate reason is that a large trocar size, leaving the fascial defect open, and stretching the port site were closely related to the occurrence of trocar site hernias.

The highlight of this review article is that the drain sites can possibly be one of the sources for bowel complications. We recommend closure of all 10 mm ports. If an intraperitoneal drain is necessary, it should be placed through a 5 mm port only.

In natural orifice translumenal endoscopic surgery (NOTES) intentional puncture of one of the viscera (e.g., stomach, rectum, vagina, and urinary bladder) is made and an endoscope is used to access the abdominal cavity and perform an intra-abdominal operation. Early studies focused on feasibility, including such accomplishments as pure transgastric splenectomy and gastrojejunostomy. Contemporary studies are investigating the infectious and immunologic implications of NOTES and honing the tools and techniques required for complex abdominal operations.

Today NOTES has entered the clinical arena in quite a few cases The first clinical series of transgastric peritoneoscopy has recently been published; many groups are accumulating patients in studies of NOTES cholecystectomy, either via the transgastric or transvaginal route; and a series of transgastric appendectomies has been well publicized, yet they remains unpublished. Although clinically NOTES is gaining momentum, the field should remain in check while rigorous studies are performed and clinical trials are undertaken. The zeal for NOTES should not take precedence over the welfare of the patient.

Laparoscopic surgery has widely spread in the treatment of colorectal cancer. For colorectal cancers, many randomized controlled trials regarding short-term outcome demonstrate that laparoscopic surgery is feasible, safe and has many benefits including reduction in a perioperative mortality. In terms of long-term outcome, four randomized controlled trials insist that there are no differences in both laparoscopic and open surgeries proving oncologic safety and that the long-term outcome is at least not inferior to open resection. However, there are still more important issues including long-term oncological outcome for advanced colon cancer, costeffectiveness and the impact on quality of life of patients.

Abdominal operations result in random and unpredictable adhesion formation. Postoperative adhesion may contribute to recurrent episodes of small bowel obstruction, chronic pain abdomen or both. Laparotomy and laparoscopy are the modes used to treat the adhesion related complications.

(1) To study the adhesion related complications and treat the same by means of laparotomy and laparoscopic procedures. (2) To study how the risk of postoperative adhesions can be minimized.

About 50 cases from March 2007 to February 2009 were studied in Government hospital, Sirsi, Karnataka, India. Patients who underwent some surgical procedures before presenting with adhesions related complications like small bowel obstruction and chronic pain abdomen were considered. Patients who required intervention were treated with surgical procedures. Patients who presented with obstructive features underwent laparotomy and who presented with chronic pain abdomen underwent laparoscopy.

All the 50 patients who were in our study had undergone some conventional surgeries in previous instance. No patient in our study had undergone laparoscopy in previous instance. Appendicectomy (40%), lower segment cesarean section (22%) were the common surgeries which resulted in adhesions. Thirty-four patients in our study presented with obstructive features, underwent laparotomy and adhesiolysis. Sixteen patients in our study underwent laparoscopy for chronic pain abdomen. Both surgeries were safe and resulted in recovery of almost all patients. We could not follow-up most of the patients after 3 months so the outcome of adhesiolysis by both procedures is not known.

(1) Conventional surgeries leads to more adhesion formation than the minimal invasive procedures. (2) Appendicectomy and pelvic surgeries are the common cause of adhesions. (3) Both laparotomy and laparoscopy can be safely used as mode of treatment of adhesion related complications. (4) Operative treatment of acute abdomen by laparoscopy can be recommended.

In laparoscopic surgery, usually a vascular pedicle or a tissue to be cut is first coagulated and later cut by scissors separately. Here the author has created an instrument with dual function of hemostasis as well as cutting without changing the instruments.

The author has used the described instrument for comparision in 16 laparoscopic appendicectomy and 14 laparoscopic hysterectomy. Here the parameter was time required for only cauterization and subsiquent cutting. Appendix was ligated by Meltzers knot.

To determine the safety of laparoscopic cholecystectomy without On-table cholangiography.

Quasi-experimental study.

Surgical “D” ward Khyber teaching hospital Peshawar from January 2005 to December 2008.

Patients of acute or chronic cholecystitis due to gallstones were included in this study while patients of obstructive jaundice and gallbladder mass were excluded. All patients were operated through laparoscopic cholecystectomy without On-table cholangiography. During procedure, bile duct injury were noted and evidences of bile duct injury were also collected postoperatively during hospitalization and follow-up visits. Data regarding complications in terms of bile duct injury were recorded and analyzed.

A total of 7 (0.92%) bile duct injuries were noted in this series. There were two (0.26%) cases of partial injury to the common hepatic duct out of which 1 was a case of Mirizzi's syndrome. In the second case, a partial injury to the common hepatic duct occurred during an attempt to cauterize the avulse branch of cystic artery. In two (0.26%) patient's partial injury to common bile duct occurred due to tenting of common bile duct. Complete transaction of common bile duct occurred in two (0.26%) cases. In one (0.13%) patient postoperative leakage was found to be due to severed cholecystohepatic duct.

The results clearly show that there is hardly any difference as far as the CBD injury is concerned with or without On-table cholangiography, provided we have a good back-up by a radiologist for pre- and postoperative ultrasound and ERCP.

Single port endolaparoscopic Surgery (SPES) has gained enthusiasm in the surgical community because of the perceived better postoperative outcome, namely a single incision. We write this prospective observational study to ascertain the feasibility and safety of this technique in patients needing two operations.

Three patients who underwent double procedures each. Case 1: Transabdominal preperitoneal hernia repair with gastric wedge resection. Case 2: Cholecystectomy with diaphragmatic hernia repair. Case 3: Oophorectomy with incisional hernia repair. Patient demographics, type of port used, operating time, complications and scar length were collected.

Operating time for the first case was 250, 210 and 105 minutes respectively. Incision length varied from 2 to 3 cm. Addition of a 5 mm port and an intraoperative complication of a laceration of the liver after suturing of the gallbladder fundus was noted in the second case.

SPES is a feasible and safe technique for approaching double procedures. It drastically reduces the number of scars that a double procedure creates and if difficulty arises another port can always be added to ease the operation.

To study the effects of enteric disturbance and CO₂ pneumoperitoneum on serum β-endorphin (β-EP) in SD rats, and discuss their influences on perioperative stress responses.

120 SPF-grade male SD rats were anesthetized intraperitoneally and equally randomized to four groups: group A, CO₂ pneumoperitoneum at 1.0 kPa; group B, a 5 cm abdominal incision without enteric disturbance; group C, a 5 cm abdominal incision with enteric disturbance; and group D, control Group. Serum β-EP was measured at 10, 20 and 40 minutes after initiation of surgery.

The serum β-EP concentration of group A was 2.74 ± 0.67 ng/ml, 1.57 ± 0.64 ng/ml and 1.64 ± 0.74 ng/ml at 10, 20 and 40 minutes of CO₂ pneumoperitoneum respectively, which was significantly higher than that of the control group (P < 0.01). The serum β-EP concentration of group B was 2.53 ± 0.86 ng/ml, 1.46 ± 0.11 ng/ml and 1.34 ± 0.14 ng/ml at 10, 20 and 40 minutes after the 5 cm abdominal incision was made, which was very significantly higher than that of the control group (P < 0.01). The serum –EP concentration of group C was 3.77 ± 0.51 ng/ml, 2.99 ± 0.70 ng/ml and 2.67 ± 0.54 ng/ml at 10, 20 and 40 minutes after the 5 cm abdominal incision was made with enteric disturbance. There was a very significant difference in the concentration of serum β-EP at 10, 20 and 40 minutes between Group C and Group B (P < 0.01).

Both enteric disturbance and CO₂ pneumoperitoneum are important stimulating factors inducing stress responses in rats. Enteric disturbance may accentuate the severity of stress responses in laparotomy.