A brief biography of Kurt Semm, the pioneer of laparoscopic appendectomy and inventor of various laparoscopic instruments are done, with special reference to his struggle to establish the foundation of minimally invasive surgery amongst his contemporary surgeons.

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Background: Abdominal lymphadenopathy (AL) - a common clinical scenario faced by clinicians - often poses a diagnostic challenge. In the absence of palpable peripheral nodes, tissue has to be obtained from the abdominal nodes by image-guided biopsy or surgery. In this context a laparoscopic biopsy avoids the morbidity of a laparotomy. Aim: This retrospective analysis of prospectively collected data represents our experience with laparoscopic biopsy of abdominal lymph nodes. Materials and Methods: Between October 2000 and November 2005, 28 patients with AL underwent laparoscopic biopsy. Pre-operative radiological imaging studies had identified a nodal mass in 20, a solitary node in 1, a cold abscess in 1 and a mesenteric cystic lesion in 1 patient. In five patients with chronic right lower abdominal pain and normal ultra-sonographic findings mesenteric nodes were identified and biopsied during diagnostic laparoscopy. Results: The sites of biopsied lymph nodes included para-aortic (10), mesenteric (8), external iliac (3), left gastric (2), obturator (1), aorto-caval (1) and porta hepatis (1). One patient with enlarged peripancreatic nodes mass and another with a mesenteric cystic mass had cold abscesses drained in addition to biopsy. There were no perioperative complications and the median postoperative stay was 2 days (range 1-4 days). Histopathology revealed tuberculosis in 23 patients, reactive adenitis in 2, lymphoma in 1 metastatic carcinoma in 1, and a retroperitoneal sarcoma in 1. Conclusions: In patients with AL, laparoscopy provides a safe and effective means of obtaining biopsy. It is of particular value in patients in whom (a) the nodes are small or present in locations unsuitable for image-guided biopsy, (b) adequate tissue cannot be obtained by image-guided biopsy or (c) previously undiagnosed lymphadenopathy is encountered during diagnostic laparoscopy.

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Laparoscopic common bile duct exploration (LCBDE) has been found to be a safe, efficient and cost-effective treatment for choledocholithiasis. Following LCBDE, the clearance may be ascertained by a cholangiogram or choledochoscopy. The common bile duct (CBD) may be closed primarily with or without a stent in situ or may be drained by means of a T-tube or a biliary enteric anastomosis. Materials and Methods: In our series of 464 patients of choledocholithiasis, 100 patients underwent closure of the CBD with an indwelling antegrade stent following LCBDE. LCBDE was performed by direct massage of CBD, saline lavage, direct pickup with choledocholithotomy forceps or by basketing. Fragmentation of impacted stones in situ was performed in a few patients. Completion choledochoscopy was performed by means of a pediatric bronchoscope. A 10-cm, 7 Fr. double-flap biliary stent was placed in situ after LCBDE. Results: There was no mortality in the series. There was no conversion either. The median duration of the operation was 75 min. The mean postoperative hospital stay was 3.5 days. One patient had a minor postoperative biliary leak. One patient had a right sub-hepatic collection. Four patients developed postoperative port infection. The stents were removed endoscopically after 4 weeks. Sixty-eight patients could be followed up till 1 year. There has been no incidence of residual disease and the patients on follow-up are asymptomatic. Conclusion: In our experience, a single stage laparoscopic treatment of cholelithiasis with choledocholithiasis is a safe, viable and cost-effective option. Closure of the CBD over an antegrade stent is a feasible option but requires advanced skills in minimal access surgical techniques, especially endosuturing. The procedure may be performed safely in expert hands without mortality and with negligible morbidity.

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Background: Previous studies have suggested that end-tidal CO ₂ (ET-CO ₂ ) may be inaccurate during one-lung ventilation (OLV). This study was performed to compare the accuracy of the noninvasive monitoring of PCO ₂ using transcutaneous CO ₂ (TC-CO ₂ ) with ET-CO ₂ in patients undergoing video-assisted thoracoscopic surgery (VATS) during OLV. Materials and Methods: In adult patients undergoing thoracoscopic surgical procedures, PCO ₂ was simultaneously measured with TC-CO ₂ and ET-CO ₂ devices and compared with PaCO ₂ . Results: The cohort for the study included 15 patients ranging in age from 19 to 71 years and in weight from 76 to 126 kg. During TLV, the difference between the TC-CO ₂ and the PaCO ₂ was 3.0 ± 1.8 mmHg and the difference between the ET-CO ₂ and PaCO ₂ was 6.2 ± 4.7 mmHg ( P =0.02). Linear regression analysis of TC-CO2 vs. PaCO ₂ resulted in an r ² = 0.6280 and a slope = 0.7650 ± 0.1428, while linear regression analysis of ET-CO ₂ vs. PaCO ₂ resulted in an r ² = 0.05528 and a slope = 0.1986 ± 0.1883. During OLV, the difference between the TC-CO ₂ and PaCO ₂ was 3.5 ± 1.7 mmHg and the ET-CO ₂ to PaCO ₂ difference was 9.6 ± 3.6 mmHg ( P =0.03 vs. ET-CO ₂ to PaCO ₂ difference during TLV; and P <0.0001 vs. TC-CO ₂ to PaCO ₂ difference during OLV). In 13 of the 15 patients, the TC-CO ₂ value was closer to the actual PaCO ₂ than the ET-CO ₂ value ( P =0.0001). Linear regression analysis of TC-CO ₂ vs. PaCO ₂ resulted in an r ² = 0.7827 and a slope = 0.8142 ± 0.0.07965, while linear regression analysis of ET-CO ₂ vs. PaCO ₂ resulted in an r ² = 0.2989 and a slope = 0.3026 ± 0.08605. Conclusions: During OLV, TC-CO ₂ monitoring provides a better estimate of PaCO ₂ than ET-CO2 in patients undergoing VATS.

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Hemangiomas of the small bowel are rare tumors that often present with gastrointestinal bleeding. Diagnosis can be difficult and exploratory laparotomy has often proved to be the only method with which to determine the presence and location of these tumors. We report two cases of small bowel hemangioma in children aged 10 and 7 years, in which the diagnosis was made by laparoscopy. Laparoscopy identifies the affected segment of bowel and allows delivery to a minimally extended umbilical port site. The avoidance of an open laparotomy helps to reduce post-operative analgesic requirement and achieves an early return of bowel function.

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Endoscopic surgery in the neck was attempted in 1996 for performing parathyroidectomy. A similar surgical technique was used for performing thyroidectomy the following year. Most commonly reported endoscopic neck surgery studies in literature have been on thyroid and parathyroid glands. The approaches are divided into two types i.e., the total endoscopic approach using CO2 insufflation and the video-assisted approach without CO2 insufflation. The latter approach has been reported more often. The surgical access (port placements) may vary-the common sites are the neck, anterior chest wall, axilla, and periareolar region. The limiting factors are the size of the gland and malignancy. Few reports are available on endoscopic resection for early thyroid malignancy and cervical lymph node dissection. Endoscopic neck surgery has primarily evolved due to its cosmetic benefits and it has proved to be safe and feasible in suitable patients with thyroid and parathyroid pathologies. Application of this technique for approaching other cervical organs such as the submandibular gland and carotid artery are still in the early experimental phase.

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Extramedullary hematopoiesis is a rare cause of an intrathoracic mass in individuals with hemolytic disorders. It can be clinically confused with other tumors of the mediastinum. While radiologic studies often demonstrate findings suggesting intrathoracic extramedullary hematopoiesis, histology is usually required for diagnostic purposes. Thoracotomy was the mainstay procedure for obtaining tissue diagnosis and resection. However, video-assisted thoracoscopy (VATS) is an amendable and less-invasive means of tumor removal. We report a case of a posterior mediastinal extramedullary hematopoietic mass in a forty-two year old male in which VATS was utilized for diagnosis and resection.

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There are rare reports of necrotizing fasciitis (NF) following laparoscopic surgery. The clinical presentation of this condition may be delayed due to non-specific symptoms and sign. The diagnosis is essentially clinical and early recognition is crucial in the management. We present a case of NF of the lower abdominal wall extending to thigh, scrotum and perianal area following the laparoscopic extraperitoneal repair of left inguinal hernia managed with extensive debridment, removal of mesh, antibiotic, and skin grafting. He was seen 6 months after his surgeries and had no disability. The extensive search on Medline, Medscape, and Google engine revealed only one case report of NF following laparoscopic total extraperitoneal repair of inguinal hernia that died and this is the second case report and the only surviving one.

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