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Under anesthesia , the instruments the surgeon uses to remove the appendix are placed through several small incisions , and the laparoscope is placed through another incision . The oligarchy was yearly becoming richer and more tyrannical , the people poorer and more dependent , and it was necessary to erect stronger and stronger barriers against such abuse of the franchise as rendered it but an instrument the more in the hands of unprincipled persons of consequence . Sterilizing the instruments the way they would be onboard a ship or in an office stateside is not an option in Meulaboh , Indonesia . That makes the instrument the coldest object in space .