Abstract
Objective: To evaluate the complications of laparoscopic cholecystectomy in symptomatic and asymptomatic cholecystolithiasis.
Design and duration: Prospective study from 1st June 2005 to 30th June 2007.
Setting: Surgical “D” Unit, Khyber Teaching Hospital, Peshawar.
Patients: All patients with cholecystolithiasis who had laparoscopic cholecystectomy.
Methodology: All patients with gallstone disease both symptomatic and asymptomatic, of both sexes and any age were evaluated by history, examination and investigations and the data collected on a proforma. Patients with chronic liver disease or those deferred by the anesthetist were excluded from the study. All patients underwent laparoscopic cholecystotomy, outcome and complications were analyzed.
Result: 351 patients underwent laparoscopic cholecystectomy in the study period. 314 (89.46%) were females and 37 (10.54%) were males. Common age group was between 21-40 years (56.41%), bleeding was the commonest complication, occurring from trocar site in 35 (9.97%), vascular injury in Callot’s triangle in 57 (16.23%) and liver bed in 39 (11.11%) cases. Spilled gallstones occurred in 37 (10.54%), biliary leak in 14 (3.98%) including CBD injury in 2 cases. Port site infection was seen in 17 (4.84%), while bowel injury was seen in only one (0.28%) cases. Conversion to open surgery was in 11 (3.13%) cases. Late complications CBD stricture and Port hernia were seen in 5 (1.42%) and 3(0.85%) cases respectively. Mortality was only 2 (0.56%).
Conclusion: LC is a safe and effective procedure in almost all patients with cholelithiasis. Proper preoperative work up, knowledge of possible complications and adequate training makes this operation a safe procedure with favorable result and lesser complications.
Keywords: Laparoscopic cholecystectomy, complications, outcome, gallstones.

Abstract
Background: Endometriosis is a common disease of reproductive age group women. It was first described by Dr Sampson in 1925 as, "presence of ectopic tissue which possesses the histological structure and function of uterine mucosa". There is controversy surrounding its pathogenesis and the mechanism by which it causes infertility. Laparoscopic surgery is often used to treat this condition. Controversy exists as to the benefits of such surgery in infertile women.
Objective: To explore whether laparoscopic surgery improves the chances of conception both by natural and assisted conception methods in moderate to severe endometriosis.
Methods: Retrospective review of English literature regarding role of laparoscopic surgery in managing endometriosis associated infertility using keywords - Endometriosis, Laparoscopy, Infertility, Pregnancy rate.
Results: A large prospective study by Adamson et al 1993 showed that laparoscopic surgery significantly increased the cumulative pregnancy rate which was confirmed by a further meta-analysis in 1994. A large retrospective analysis by Osuga et al 1997 reported that pregnancy rate is unrelated to the stage of endometriosis. Further studies in 2002 suggested that the laparoscopic surgery increases the pregnancy rates in the first 6-12 months post operation. Two randomized controlled trials demonstrated higher pregnancy rates after laparoscopic excision of endometriomata. Few studies showed the benefits of laparoscopic endometrioma excision before IVF like reduced oocyte retrieval risks, missing occult malignancy and worsening of endometriosis during ovulation stimulation overweighs the drawback of cost and surgical risk. In addition, studies have reported improvement of dyspareunia after laparoscopic debulking for rectovaginal endometriosis.
Conclusion: There are no large prospective randomized double blind controlled trials available to date in this area. In spite of heterogenicity among the available studies, current evidence suggests that laparoscopic excision or ablation, either by electrocautery or laser is beneficial in improving pregnancy rates, both by natural and assisted.

Abstract
A 28-year-old male was identified to have a right sided undescended testis, on his master health check-up. Ultrasound examination identified the testis to be in the inguinal canal near the deep ring. The patient was counseled of the consequences of undescended testis in the adult and after obtaining his fully informed consent he underwent a laparoscopic right orchidectomy and mesh repair.
This article highlights the consequences of undescended testis, the various modalities of investigation, treatment and also emphasizes on the role of laparoscopy in its management.
Key words: Undescended testis, cryptorchidism, orchidectomy, laparoscopy.

Abstract
Open appendectomy is the ‘gold standard’ for the treatment of acute appendicitis. Laparoscopic appendectomy though widely practiced has not gained universal approval. Although it is a generally safe operation, postoperative complications occur in few patients. Laparoscopic appendectomy was first described in 1983. Reports of early studies were equivocal with few studies evaluating analgesic requirements and the length of hospital stay. This study was aimed to compare laparoscopic with open appendectomy and ascertain the therapeutic benefit, if any, in the overall management of acute appendicitis.
Key words: Laparoscopic appendectomy, Appendectomy, Appendicitis, Laparoscopic vs open appendectomy.

Abstract
Background: Nausea and vomiting are frequent after general anesthesia ,the most important causes of morbidity after anesthesia and surgery are postoperative nausea and vomiting.
Methods: A comparative analysis of published articles was done to determine the relative efficacy and safety of ondansetron, droperidol, metoclopramide, dexamethasone, and intravenous crystalloid fluid for the prevention of postoperative nausea and vomiting. I performed a literature search of English references using both the MEDLINE database and a manual search. Double-blinded, randomized, controlled trials comparing the effect of these agents in reduction or prevention of postoperative nausea and vomiting.
Results: A total of 60 studies were identified, of which 6 were excluded for methodological concerns. For each comparison of drugs, ondansetron (P < 0.001), droperidol (P < 0.001) were more effective than metoclopramide in preventing vomiting. We conclude that ondansetron and droperidol are more effective than metoclopramide in reducing postoperative nausea and vomiting. The incidence of vomiting was reduced in the intravenous administration of crystalloid 30 mg/kg in healthy adults (P = 0.001) and for dexamethasone is (P < 0.03).
Conclusion: In summary, both ondansetron and droperidol were more effective than metoclopramide, intravenous crystalloid fluid and dexamethasone in preventing postoperative vomiting.
Key words: Laparoscopy postoperative nausea and vomiting, droperidol, metoclopramide, ondansetron, IV crystalloid.

Abstract
Background: The laparoscopic approach to myomectomy has raised questions about the risk of uterine rupture in patients who become pregnant following surgery. It has been suggested that the rupture outside labor in pregnancies following laparoscopic myomectomy can be due to the difficulty of suturing or to the presence of a hematoma or to the wide use of radiofrequencies.
Aim: To assess the outcome of pregnancy following laparoscopic myomectomy.
Methods: A literature search performed using engine Google, High wire press, Springer link, and Yahoo. Selected papers screened for other related reports.
Results: There were no incidents of uterine scar rupture in any of these studies.
Conclusions: Uterine rupture during pregnancies following laparoscopic myomectomy is rare. This review article did not confirm the hypothesis that laparoscopic myomectomy is associated with an increased risk for uterine dehiscence during pregnancy.
Key words: Laparoscopic myomectomy, pregnancy, and uterine rupture

Abstract
Background: Despite a large number of clinical studies in recent years no consensus has been achieved on the surgical technique of inguinal hernia repair for various reasons. “Experts” believe that their own preferred open methods have the lowest possible recurrence and complication rates. They tend to attribute any negative results, as shown by a number of regional quality studies, to other surgeons’ poor skill rather than to the technique itself. This review article aimed to compare laparoscopic versus open Laparoscopic hernia repair.
Key words: Laparoscopic inguinal hernia repair, Hernioplasty, Inguinal hernia, Laparoscopic vs open inguinal hernia repair.

Abstract
The advent of laparoscopic surgery has changed the concept of surgery from prolonged painful to painless, cosmetically satisfying and short stay. In the past few years many instruments have been developed and introduced into the operating room (OR), but there has been ongoing debate about the optical ergonomic posture of the operating surgeon.
One of the main ergonomic problem in our currently available operating room table is that they are designed for the open surgery and are not ideal (suitable) for the laparoscopic surgery. Since laparoscopic surgery requires the use of longer instruments than open surgery, thus changing the relation between the height of the surgeon and the desirable height of the operating room table.
This study aims to understand an ergonomically optimal operating table height required for the particular height of the surgeon from the floor so that they can perform their surgery comfortably.
The operating table height was defined as the upper level of the table from the floor. The study was undertaken keeping all other variables fixed (Elevation angle, Manipulation angle, Azimuth angle, Distance of monitor.) Coaxial alignments were maintained. The only variable was the operating room (OR) table height.
Key words: Ergonomics, Laparoscopy, Operation Table Height.

Abstract
TP Wright originally introduced the concept of a learning curve in aircraft manufacturing in 1936.¹ He described a basic theory for costing the repetitive production of airplane assemblies. The term was introduced to medicine in the 1980s after the advent of minimal access surgery. It also caught the attention of the public and the legal profession when a surgeon told a public enquiry in Britain that a high death rate was inevitable while surgeons were on a learning curve.² Recently it has been labeled as a dangerous curve³ with a morbidity, mortality and unproven outcomes. Yet there is no standardization of what the term means. In an endeavor to help laparoscopic surgeons towards evidence based practices this commentary will define and describe the learning curve, its drawing followed by a discussion of the factors affecting it, statistical evaluation, effect on randomized controlled trials and clinical implications for both practice and training, the limitations and pitfalls, ethical dilemmas and some thoughts to pave the way ahead.