In Nepal, it is quite common to find patients with large stone burden and thick gallbladder wall which often leads to incision extension. We have used this extended incision to our advantage. The present technique of two-port Laparoscopic cholecystectomy not only helps overcoming the specimen extraction difficulties but also contributes to better cosmesis.

Total of 25 patients were underwent the surgery in 2008 to 2010.

The mean operating time was 50 minutes. None had significant procedural blood loss, iatrogenic injury, perforation of gallbladder, bile spillage, significant gas leak or subcutaneous emphysema at either port site. All patients were comfortable in the postoperative period and were routinely discharged on 2nd postoperative day except for 2 patients who has surgical site infection and fever respectively. Although 3 cases were converted to standard four-port technique, none required conversion to open cholecystectomy. Out of 25 patients, 7 cases have completed 3 months follow up and did not show any complication like port site hernia.

The described method of performing 2 port laparoscopic cholecystectomy is safe, simple and inexpensive yet cosmetically rewarding.

Misro AK, Sapkota P. Two-port Laparoscopic Cholecystectomy: An Initial Experience of 25 Cases with a New Technique. World J Lap Surg 2016;9(1):1-4.

To evaluate the analgesic effect of intraperitoneal tramadol in patients undergoing laparoscopic cholecystectomy.

Prospective, double blind, randomized study

A total of 100 patients undergoing laparoscopic cholecystectomy were randomized into two groups I and II of 50 patients each: Group I received intraperitoneal tramadol 100 mg (diluted in 20 ml of distilled water) immediately after induction of pneumoperitoneum and just before removal of trocars. Similarly, Group II received 20 ml of intraperitoneal normal saline. All patients had a standard anesthetic. Rescue analgesia was with diclofenac sodium. Postoperatively, visual analog scale scores, 1 and 24 hours diclofenac consumption, postoperative hospital course, and adverse effects were recorded.

Student's t test and Epi Info statistical software.

Pain intensity is significantly less in group I than in group II in the first 4 hours, while requirement of analgesic postoperatively is significantly less in group I than in group II in the first 8 hours except at 30 and 60 minutes. Better control of blood pressure and respiratory rate was seen in group I in the first 4 hours. There was no significant difference between the two groups regarding postoperative hospital course and incidence of adverse effect.

Intraperitoneal tramadol provides superior postoperative analgesia in the early postoperative period after laparoscopic cholecystectomy compared with normal saline in patients undergoing laparoscopic cholecystectomy.

Jairath A, Gupta S, Singh K, Katyal S. Can Intraperitoneal Tramadol decrease Pain in Patients undergoing Laparoscopic Cholecystectomy in the Postoperative Period? A Randomized controlled Trial. World J Lap Surg 2016;9(1):5-8.

To assess the feasibility of singleincision laparoscopic cholecystectomy (SILC) with conventional laparoscopic instruments and to compare it with four-port conventional laparoscopic cholecystectomy (LC) regarding various intraoperative and postoperative factors.

This is a prospective randomized controlled study carried out at Santosh Medical College and Hospitals, Ghaziabad from March 2014 to September 2015. This study included 60 patients with cholelithiasis who were divided into two groups of 30 patients each. Group I was offered four-port conventional LC and group II underwent SILC.

Cholelithiasis was commonly seen in young females. Single-incision laparoscopic cholecystectomy took more operating time than conventional LC due to more operative difficulty. Outcome of SILC was 79.6% (23 of 30). However, postoperative complications and pain (measured by visual analog scale scoring system) were almost the same in both groups. Cosmetic outcome was better in SILC group.

Single-incision laparoscopic cholecystectomy has no added advantage over conventional LC, but it can be performed in selected patients for better cosmetic results.

Goel A, Chaubey P, Gupta A, Gupta S, Agarwal A, Bhardwaj D. Comparative Study of Single-incision Laparoscopic Cholecystectomy with Four-port Conventional Laparoscopic Cholecystectomy: A Single-center Experience. World J Lap Surg 2016;9(1):9-12.

Laparoscopy as a modality for the diagnosis of pelvic pathology has been well-established in recent times. Besides aiding in diagnosis, it is an important tool for management in the same sitting preventing unnecessary laparotomy in many cases.

The aim of the article was to know the common indications of performing diagnostic laparoscopy, intraoperative findings, and various interventions done during surgery. It was also aimed to highlight the importance of laparoscopy as a minimum basic requirement for diagnosing many common pelvic pathologies.

Indications for laparoscopy, intraoperative findings, and interventions done during surgery were studied in 75 patients who underwent laparoscopy between January 2012 and December 2014 at Gian Sagar Medical College and Hospital.

Maximum number of patients (75; 76%) were in the age group of 21 to 30 years. The main indication for laparoscopy was infertility in 58 cases (77.33%) followed by chronic pelvic pain in 4 cases (5.3%). Tubal factor was the commonest cause of infertility seen in 19 (32.75%) cases. In majority of patients with previous history of tuberculosis, adhesions were found to be the cause of chronic pain and infertility. Ovarian drilling was the most common intervention done in 12 cases and adhesiolysis in another 11 cases.

Laparoscopy is an essential intervention in detecting many pelvic pathologies which are difficult to diagnose on clinical examination. Its diagnostic and therapeutic potential has made it a safe, feasible, and less invasive modality for evaluation of infertility, chronic pelvic pain, and endometriosis.

Bhutani N, Kaur H, Sharma S. Laparoscopy in Gynecology: Experience from a Rural Hospital. World J Lap Surg 2016;9(1):13-16.

Federal Medical Centre, Gombe is one of the tertiary hospitals located in the northeast of Nigeria. It serves as a referral center to neighboring states and also gives secondary care to the immediate environment. The institution has evolved in providing minimal access surgery services in appendicectomies, cholecystectomies, diagnostic laparoscopy, endourology, etc. We present our experience in laparoscopic appendicectomies.

To share our experience in general surgery unit in laparoscopic surgery.

One-year review (May 2013 to February 2014) of patients who underwent laparoscopic appendicectomy was made. Recruitment for the procedure was done from patients who presented at the Emergency Department (ED) or at the Surgical Outpatient Department (SOPD). All patients who had complications and previous abdominal surgeries or had cardiopulmonary disease were excluded. Patients were counseled and written consent for conversion to open surgery was obtained.

Twenty patients who had laparoscopic appendicectomy were reviewed. All had successful surgery; there was no conversion to open. Mean operative time was 34.2 minutes; mean recovery period was 181 minutes (3 hours), mean pain perception was 2.55 (mild pain), mean hospital stay was 22 hours. They were followed up at the SOPD and none of them had port site wound infection or clinical evidence of other complications.

Laparoscopic appendicectomy is a favorable option in the treatment of uncomplicated appendicitis. Early recovery, reduced pain, and reduced hospital stay are the outcomes observed.

Mshelia NM, Obiano SK, Guduf MI, Gital YS, Khalifa S. Our Experience in Laparoscopic Appendicectomy in a Federal Teaching Hospital in Gombe. World J Lap Surg 2016;9(1):17-21.

The use of laparoscopic techniques in general surgery has gained increasing popularity in the last few decades. Patients undergoing laparoscopic cholecystectomy do experience postoperative pain mainly in the upper abdomen, back, and shoulder region that needs narcotic injection as a pain reliever. Intraperitoneal injection of local anesthetic has been proposed to minimize postoperative pain after laparoscopic cholecystectomy.

The aim of this study is to compare the effectiveness of intraperitoneal ropivacaine hydrochloride installation with intramuscular tramadol injection for postoperative pain.

In this study, 400 patients of either sex in the age group of 23 to 62 years with American Society of Anesthesiologists grade I and II, who were scheduled to undergo elective laparoscopic cholecystectomy, were allocated to two groups of 200 patients each with regard to postoperative analgesia. In group I (n = 200) the patients received ropivacaine (0.5%), instilled in gallbladder bed and the undersurface of diaphragm and infiltration of port wounds. In group II (n = 200) the patients were provided with postoperative analgesia with tramadol (100 mg) given intramuscularly (IM) at the completion of procedure. The intensity of postoperative pain using visual analogue scale (VAS) and shoulder pain was evaluated and also other pain-related sequelae were recorded.

Both VAS and shoulder pain score had significantly improved postoperatively in group I in comparison with group II. At the same time, ropivacaine instillation in group I lowers significantly postoperative nausea and vomiting resulting from either postoperative pain or tramadol injection.

Intraperitoneal installation of ropivacaine hydrochloride reduces the intensity of visceral, parietal, and shoulder pain in comparison with IM tramadol injection.

Saxena A. Smartphone/Tablet-based Laparoscopy Simulation System: A Low-cost Training Module for Beginners in Minimally Invasive Surgery. World J Lap Surg 2016;9(1):26-29.

Tranexamic acid (TXA) is an antifibrinolytic drug that has the property to reduce intraoperative and postoperative bleeding. This study was intended to establish the effect of TXA in minimizing the intraoperative and postoperative blood loss in laparoscopic sleeve gastrectomy.

This was a prospective follow-up study conducted in Sabah Hospital, Kuwait, over 4 months from September 2014 to December 2014. A total of 50 patients who underwent laparoscopic sleeve gastrectomy were included in this study; 25 patients were given tranexamic acid during induction and 25 did not receive. Selection of patients was done on a random basis. Intraoperative blood loss, visibility of field of surgery, and amount of blood collected in suction apparatus used during surgery.

Each group consisted of 25 patients. Preoperative intravenous bolus administration of TXA at 10 mg/kg reduces blood loss.

Tranexamic acid is an antifibrinolytic agent that inhibits the action of plasmin. There is also reduction in blood level of D-dimer. It is seen to significantly reduce intraoperative blood loss during surgery. Additionally, there seems to be no alterations of coagulation parameters or untoward systemic effects. This should prompt further trials.

Alhomoud H. The Effect of Tranexamic Acid on Blood Loss during Laparoscopic Sleeve Gastrectomy. World J Lap Surg 2016;9(1):30-33.

Jayachandran A. Stump Cholecystitis. World J Lap Surg 2016;9(1):34-37.

Minimal access surgery often offers better visualization than conventional surgery, particularly better visualization of the hiatus and deep structures in the pelvis.

Laparoscopic surgery offers dramatic advantages in terms of the quality of life after the operation.

Operating time is longer.

Numerous new techniques, technologies, and guidelines have been introduced to eliminate/decrease the risks associated with entry techniques in laparoscopy.¹ The two major entry techniques widely carried out include the closed technique (Veress) and open technique (Hasson). The other techniques employed include use of direct trocar insertion, use of disposable shielded trocars, radially expanding trocars, and visual entry systems. No single method or equipment has been proven to eliminate laparoscopic entry-associated injury.

A systematic electronic search was conducted and various articles were studied and reviewed and this review article was prepared.

Zaman M, Mishra RK, Singal R, Shah A, Sharma BP. Complications as a Result of Entry Techniques for creating Pneumoperitoneum and Recommendations to minimize Them in Laparoscopic Surgery: A Review of Literature. World J Lap Surg 2016;9(1):38-40.

Bada VC, Narkhede RA. Proximal Small Intestinal Obstruction: A Rare Presentation of Splenosis. World J Lap Surg 2016;9(1):41-43.

Alhomoud H. Retrorectal Schwannoma. World J Lap Surg 2016;9(1):44-46.

Soppimath SS, Srishail C, Padasali P. Laparoscopic Entry: A Hybrid Technique of Open Hasson and Direct Trocar Access. World J Lap Surg 2016;9(1):47-49.