A 30-year-old male presented at our hospital with pain in the front of the right thigh, for which he had undergone a series of investigations by the neurologists. MRI showed a large lump within the right psoas muscle, in close relationship to L2 nerve root, and at a level that was 2cm below the lower pole of the right kidney. There were areas of degeneration in the central aspect of the tumour, which showed medial intracanalicular extension along the root of L2. The radiological appearance was highly suggestive of schwannoma with an extension to L2 nerve root. The anatomical position of the schwannoma was intra-psoas. After detailed discussion with the patient about a possible need of open surgery and probability of injury to the lumbar sacral plexus in close relation to the tumour, we proceeded with laparoscopic surgery technique Patient was placed in supine position with legs split, surgeon stood between the legs of the patient and the camera person was to the left side of the surgeon, first assistant to the right side. We decided to proceed with an intraperitoneal approach to the retroperitoneum, with medial colonic reflection. Initially it was accessed through the suprapubic port with the left hand working port in the right iliac fossa and the right hand working port in the left iliac fossa, augmented by a 10mm port through the umbilicus that was used initially for right hand working, and was later used for the telescope.Initially the terminal ileum, the appendix, and the caecum were mobilized and lifted off the retroperitoneum. Then the port in the left iliac fossa was used to grasp these structures and reflect them medially and right hand working port through the umbilicus was used to continue the right paracolic dissection upto to the hepatic flexure and then to turn medially in order to expose the complete retroperitoneum [Table/ Fig-2].The anterior surface of the Gerota's fascia was completely exposed upto the level of the adrenal gland. The right ureter was identified and traced throughout its course [Table/ Fig-3].Progressive medial mobilization of the right colon allowed us to identify and preserve the duodenum and the complete Inferia Vena Cava (IVC). At this stage the psoas and the ilio-psoas tendon were both seen clearly. By correlation with the MRI we were able to then do a psoas split (a longitudinal 5cm muscle split of the psoas major lateral to genito-femoral nerve which was identified and preserved).Wide longitudinal splitting of psoas major helps to expose the anterior surface of the capsule of the tumour [Table /Fig-4]. By careful dissection just outside the capsule, and by coagulating and dividing all the feeding vessels to and from the tumour, a plane was developed all around. We found the suture traction technique to be useful, and would like to recommend it too. Sutures were taken on the capsule of the tumour with 2-0 polypropolene which were held with the needle holder for retraction to expose further the surface and edges of the tumour [Table /Fig-5].The medial dissection was kept to...

In Arnold Chiari (kee-AHR-ee) II malformation elongated cerebellar tonsils are displaced inferiorly through the Foramen Magnum into the upper cervical spinal canal. It is a complex anomaly with skull, dura, brain, spine and cord manifestations. Meningomyelocele is seen in all cases. We present a case of type II Arnold Chiari Malformation diagnosed in utero in a pregnant lady .There was no periconceptional folic acid supplementation. As the role of the Methylene Tetra Hydro Folate Reductase gene polymorphism in neural tube defects is becoming evident, a simple opportunity as folic acid supplementation should not be missed. Folate supplementation as fortification of cereal grains will also prevent other conditions like congenital heart defects, urinary tract anomalies, orofacial defects, limb defects and pyloric stenosis.

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Retrocaval ureter is a rare developmental anomaly with an incidence of 1 in 1500 births. The inferior vena cava compresses the ureter posteriorly, causing upstream dilatation of the proximal ureter and the kidney. We report a 16-year-old girl who presented with right flank pain, diagnosed as retrocaval ureter with ultrasound, intravenous urogram and CECT, and was treated with laparoscopic transperitoneal ureteroureterostomy. Embryological aspects and laparoscopic technical considerations are highlighted in this case report.

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Diaphragmatic eventration is an uncommon malady, underdiagnosed and often treated only in emergent situations. Eventration of the diaphragm is best treated by plication of diaphragm with or without meshplasty. Various studies have shown that thoracoscopic plication is as efficient as laparotomy or laparoscopic plication. We present here the report of thoracoscopic diaphragmatic plication for eventration performed in the third trimester of pregnancy in a 28-year-old woman who presented with acute respiratory distress. To our knowledge, we believe this to be the first published case in medical literature.

Although 2(nd) Branchial arch fistulae (from incomplete closure of Cervical sinus of His) are well known, 1(st) arch fistulae are much rarer (<10%) and are usually not tackled comprehensively. We present a case of a rare first branchial arch fistula of the type II Arnot classification, which presented with two external openings of more than 20 years duration. Patient had a successful resection of all the concerned fistulous tract. Review of literature and the surgical challenges of the procedure are presented herewith.