11.6.20

Called by dr Vikram while operating for right undescended testis in a 25 years old male but unable to find the testis in the inguinal canal.

The testis was easily located in the abdomen laparoscopically and removed laparoscopically through the inguinal incision already made.

22.7.20

An apparently easy lap chole became difficult due to two unforeseen problems – firstly due to the gall bladder being intrahepatic and secondly due to the small stones stuck in the fibrosed neck above which the gall bladder apparently narrowed down to the calibre of the cystic duct.

The first problem (the intrahepatic gall bladder) led to difficult and bloody dissection of the cystic artery which was eventually controlled. The second problem caused a fallacy of perception giving the appearance of the cystic duct to the infundibulum of the gall bladder. The dissection here too became very difficult and led to a tear in what was taken to be the cystic duct. A reappraisal of the thought process led to some dissection very low down and deep down to eventually find the real cystic duct just below the fibrosed neck of gall bladder with small impacted stones in it.

Just another example of visual fallacy of perception that so often causes trouble in lap chole.