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The incidence of bile duct injury in laparoscopic cholecystectomy is 0.3% to 1.0%. This is higher than the incidence reported for open cholecystectomy (i.e., 0.1-0.2%), and the surgeons all over the world are relentlessly trying to find the ways and means to lower this incidence. Various operating strategies, techniques, and instrumentations such as the 0 degrees telescope, intraoperative cholangiogram, hydrodissection, and peanut gauze dissection have been claimed by various authors to minimize the risk of bile duct injury during cholecystectomy. However, the surgical fraternity agrees that there has been no substitute for meticulous dissection and display of various vital structures near the common bile duct. The authors describe seven anatomic landmarks encountered during laparoscopic cholecystectomy that assist in safe dissection to prevent bile duct and vascular injury. On the basis of their experience, they believe that if surgeons adhere to these landmarks, excellent results can be achieved.

Background:Air pollution due to road traffic is a serious health hazard and thus the persons who are continuously exposed, may be at an increased risk. Although several studies have confirmed the ill effects of air pollutants on the lung function of traffic policemen, only a few have investigated the relationship between respiratory health and duration of exposure in this category of occupationally exposed persons.Aim:The study was carried out with the aim of evaluating the extent of impairment in lung function in traffic policemen in respect to an unexposed control group having the same age group.Materials and Methods:A cross-sectional study was conducted in which the spirometric parameters of a group of 100 nonsmoking traffic policemen, aged 20-55 years, working in and around Patiala city, were compared with those obtained in an age-matched control group, consisting of 100 healthy males, serving in the Punjab Police, who have never done traffic duty and are thus not exposed to traffic pollution. Lung function was done with MEDSPIROR. The data on the overall health status of the subjects was collected using the standard Respirator Medical Evaluation Questionnaire. The statistical analysis was carried out with SPSS PC software version 13.Results:Traffic policemen recorded a significant decline in various parameters, such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate (PEFR) when compared with controls, and is probably due to exposure to vehicular pollution. It was also observed that in traffic policemen with >8 years of exposure, the values of FVC (2.7 L), FEV1 (1.8 L), and PEFR (7.5 L/s) were significantly lower than those obtained in traffic policemen with <8 years of exposure, in whom the values were 2.9 L, 2.3 L, and 7.7 L/s for FVC, FEV1, and PEFR, respectively.Conclusion:The effect of pollution by vehicular exhausts may be responsible for these pulmonary function impairments.

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