the 20 century witnessed a myriad of advances in technology , which have found several applications in the field of medicine .
video technology was one of the most important factors that enhanced the ability of surgeons to perform complex laparoscopic surgeries .
the advantages of laparoscopy were realized in adult surgeries long before its acceptance in pediatric surgery .
the reasons for initial non - acceptance included lack of suitable equipment for the pediatric patient , uncommon need for cholecystectomy and perhaps the traditionally smaller incisions in pediatric patients making the cosmetic benefit of laparoscopy less evident .
currently , laparoscopy can now be performed in infants weighing less than 1.5 kg without significant mortality or morbidity .
the advent of minimal access technique of laparoscopy marked a new dawn in surgical care of patients .
video - laparoscopy allows surgical assistants ; anesthesiologists and nurses to view what the surgeon is doing and to actively participate in the procedure in their respective roles .
the other benefits of laparoscopy include less post - operative pain , post - operative morbidity , early recovery and return to normal activity with shorter hospital stay .
the cosmetic advantage has played a major role in the acceptance of this type of surgery amongst patients .
a developing country like nigeria with a lean health budget and an unresolved primary communicable disease challenge has been slow in joining the trend .
there is still a palpable skepticism even among surgeons of the feasibility and relevance of laparoscopy in our environment .
albeit pioneering efforts are documented from some parts of the country highlighting the feasibility of this minimal access practice despite immense challenges with a clarion emphasis on local adaptations . to the best of our knowledge ,
this is the first documented study from the niger delta region to evaluate laparoscopy as a useful tool for management of common surgical abdominal conditions in a developing country .
this is a prospective outcome study of all consecutive surgical patients who had laparoscopic procedures in general and pediatric surgery units of our institution - a regional tertiary health facility , from august 2011 to december 2012 .
patients were selected after clinical , laboratory and radiological evaluation to exclude significant co - morbidities .
an american society of anesthesiology class not greater than 2 was an inclusion criterion . in cases of adhesive small bowel obstruction ,
a non - dedicated theatre suite was used with a combination of privately - sourced and hospital equipment . in the absence of a trained endoscopy nurse or technician ,
resident doctors in the unit were trained by the operating surgeon on equipment handling and disinfection of laparoscopy instruments .
there was non - invasive monitoring of temperature , spo2 , blood pressure , respiration , pulse rate and urinary output .
there was manual ventilation and no functional capnography . based on surgeon 's preference and presence of previous abdominal scar a closed or open technique
visibility was achieved with a 30 10 mm laparoscope mounted on a karl storz ( germany ) or hawk ( china ) single - chip camera unit connected to a video monitor .
the light source was from either a karl storz 175w xenon cold light or hawk halogen light sources .
two or three ports were used in the diagnostic laparoscopies and conventional 3-ports ( 10 mm optical and two 5 mm working ports ) were used for laparoscopic appendicectomy .
there was random lateralization or centralization of the optical port i.e. 5 mm working ports at either left iliac and supra - pubic or right lumbar and left iliac fossa respectively to compare ergonomic advantage .
tissue retrieval was routinely carried out using the cannula method and scarcely with an endo - bag .
the age range was from 2 to 65 years ( mean : 32.27  17.86 years ) .
the surgeries included : six laparoscopic appendicectomies , five diagnostic laparoscopies  biopsy , one laparoscopic - assisted orchidopexy , two laparoscopic adhesiolysis for adhesive small bowel obstruction and one trans - abdominal pre - peritoneal hernia repair for adult bilateral inguinal herniorrhaphy [ figure 1 ] .
the patients for laparoscopic appendicectomy had an even sex distribution ( male : female 1:1 ) .
all were successfully completed irrespective of the position of the optical port [ table 1 ] .
laparoscopic surgery during study period laparoscopic appendicectomies performed a case of chronic abdominal pains had no pathology observed during diagnostic laparoscopy .
the positive findings during the other diagnostic laparoscopies performed are as shown in table 2 .
operating time was from 40 to 300 min and challenges encountered included power outages , equipment failures and technical difficulties .
oral sips of water was commenced within 24 h and patients discharged by 2 day post - operation except for a case of conversion for an intra - abdominal tumor ( soft - tissue sarcoma ) from uncontrollable bleeding .
surgical complications encountered were grade i and ii of the clavien - dindo classification : one wound dehiscence of a 5 mm port site ; two post - operative pyrexia ; one neuropraxia of superficial peroneal nerve and leg edema from pressure effect of stirrup in lithotomy position during evaluation of the pelvis prior to an appendicectomy .
a two - center study from the south - eastern part of the country also had laparoscopic appendicectomy as the most performed procedure .
this is probably due to the fact that acute appendicitis is a common abdominal pathology and laparoscopic appendicectomy requires basic laparoscopic skills to execute .
the lateralization or centralization of the optical port was observed not to have a significant effect on the outcome of laparoscopic appendectomy in the early career of a laparoscopic surgeon since all cases were successfully completed .
there was no laparoscopic cholecystectomy due to a low incidence of gall stone disease in our center .
the open hasson port technique is favored by many surgeons in view of less likelihood of visceral and vascular injury , however , the closed access method using the veress needle is safe , fast and efficacious even in children of all ages .
we routinely used the closed access method in the absence of previous abdominal surgery ; however following access the working ports were inserted under direct vision .
a two - port laparoscopic and single port laparoscopic appendicectomy are feasible but these have limitations in conditions of extensive adhesion and gangrenous appendix .
there was no perforation of viscus , blood vessel injury nor hemodynamic instability resulting from capnoperitoneum peri - operatively .
this conversion rate of 6.7% ( n = 1 ) is similar to 4.1% ( n = 1 ) recorded from 24 laparoscopic surgeries performed in a tertiary health facility in nigeria .
comparatively , another nigerian study of 145 laparoscopic surgeries recorded a conversion rate of 0.027% ( n = 4 ) .
some other challenges encountered during were power outages and lack of trained support staff ( endoscopy nurses and technicians ) .
the onus is on the laparoscopic surgeon to acquire an in - depth knowledge of all aspects of the practice from a certified oversea or on - site training to effectively train his support team .
it is important to note that the operational cost for laparoscopy is not huge after initial set - up i.e. , training of personnel , acquisition of equipment and relevant infrastructure .
cost reducing measures adopted included : use of reusable instruments , cannula method for tissue retrieval and the choice of extracorporeal knot placement for ligation . these measures though cheap and effective prolong set - up and operating time . in the face of competing theatre usage
the practice of laparoscopic surgery in our environment is feasible and safe despite the numerous , but surmountable challenges .
an institutional will to achieve a routine laparoscopy in a resource - poor setting is achievable with adequately trained surgeons , support staff and necessary infrastructure .
 background : video - laparoscopic surgery has long been practiced in western countries ; however documented practice of this minimal access surgical technique are recently emanating from nigeria . to the best of our knowledge , 
 this is the first documented study on laparoscopic surgery from the niger delta region.aim:to evaluate the feasibility of laparoscopy as a useful tool for management of common surgical abdominal conditions in our environment.patients and methods : this was a prospective outcome study of all consecutive surgical patients who had laparoscopic procedures in general and pediatric surgery units of our institution from august 2011 to december 2012 . 
 data on patient 's age , gender , indication for surgery , duration of hospital stay and outcome of surgery were collected and analyzed.results:a total of 15 laparoscopic procedures were performed during this study period with age range of 2 - 65 years ; mean : 32.27  17.86 years . 
 there were 11 males and four females . 
 six laparoscopic appendicectomies , one laparoscopy - assisted orchidopexy , five diagnostic laparoscopy  biopsy , one laparoscopic trans - abdominal pre - peritoneal herniorrhaphy for bilateral indirect inguinal hernia and two laparoscopic adhesiolysis for small bowel obstruction were performed . 
 all were successfully completed except one conversion ( 6.7% ) for uncontrollable bleeding in an intra - abdominal tumor.conclusion:the practice of laparoscopic surgery in our environment is feasible and safe despite the numerous , but surmountable challenges . 
 there is the need for adequate training of the support staff and a dedicated theatre suite . 
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