An attempt at a percutaneous retroperitoneoscopic approach to ureterolithotomy.

The extensive laparoscopic tubectomy programs organized by the Indian government during 1978-1981 as a measure to curb the population explosion brought some unanticipated problems for the authors. One of these, surgical emphysema, gave the authors the opportunity to explore laparoscopically extraperitoneal appearances. So deliberate retroperitoneal surgical emphysema was created, to isolate the ureter so as to locate the stone in it, and to study the feasibility of its removal via laparoscopy itself. The procedure entails minimal trauma and gives the considerable advantage of clear vision for total removal of stone(s). This procedure offers an alternative to the conventional method and to other, newer methods. The conventional method involves wide exposure with attendant morbidity and prolonged hospital stay. Other newer methods require high-tech multimode prerequisites, such as a extracorporeal shock-wave lithotriptor, ultrasound, screening, software, endourological instruments (including lithotriptor), necessarily supplemented by technical experts in each field. Hence such methods require an institutional arrangement at an exorbitant cost to the patient.

Laparoscopic appendicectomy.

Occasionally the surgeon has to venture into exploratory laparotomy, in order to confirm his assessment and also to treat accordingly. However, laparoscopy has become a means of minimising such situations for the surgeon. Against this background few surgeons have of late, been using the laparoscope for confirming or discounting the particular pathology before proceeding to laparotomy. The laparoscopic procedure needs adequate knowledge, experience and precision in handling the instruments. The recent extensive upsurge in female sterilization via the laparoscope in India has made it possible to develop techniques which are new and different from the ones practiced in developed countries. Compelling occasions on the author leading to successful closure of the trochar perforation of the colon on the spot with the help of a band applicator alone has led to the concept of appendicectomy in practice; More so with the author's modified band applicator. This procedure can readily be mastered by the endoscopic surgeon.