The advent of H2 blockers and proton pump inhibitors resulted in the virtual of peptic ulcer surgery. Most patients with peptic ulcer do not require surgery, but a small percentage of patients with perforated ulcer or resisted to medication do. Recently the indications for laparoscopic surgery have been extended to include paptic ulcer operations because of the improvement of laparoscopic surgical techniques. In this article, we present laparoscopic surgery for peptic ulcer.

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[in Japanese]

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Laparoscopic appendectomy is the most benificial procedure for patients in all laparoscopic operations. The miniture endo-surgical system for laparoscopic operation can bring less invasion and small scar to patients, compare to ordinaly system.
Usually, younger patients are suffered from acute appendicitis, therefore laparoscopic appen-dectomy using small operating tools is more beneficial. The author report the standard technique of laparoscopic appendectomy using miniture endo-surgical system.

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The procedure of laparoscopic surgery for ileus is described. The indications of this surgery are 1) the cases that are not improved by the conservative therapy. 2) the cases that have stenosis in the bowel, and 3) the cases that repeat ileus. The first trocar is inserted at least 3 cm far from the previous operation wound by the open method. The dilate intestines, the position of the ileus tube and intestinography give the useful information to assume the responsible lesion of ileus. In case the intestines adhere firmly, or the existence of stenosis (i.e., cancer), the method should be changed to the surgery with laparotomy. After the adhesiotomy, thorough observation of the whole intestine is needed to find the overlooked origin and the injured portion during the operation.
The adhesiotomy has been widely performed to the cases which do not improved by the conservative therapy. However, the adhesiotomy also causes another adhesion and ileus occasionally. The laparoscopic adhesiotomy is paid attention because of its low invasive feature and its flexibility.

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Laparoscopic splenectomy has advantages as the minimally invasive surgery for the patient the same as the other laparoscopic treatments. Immune thrombocytopenic purpura (ITP) and hereditary spherocytosis (HS) are commonly applied to this surgery due to relative small size of spleen. Recently portal hypertension with splenomegaly is able to apply to laparoscopic splenectomy according to improvement of instruments and surgical techniques. Recent improvement of surgical stapler allows to ligate the splenic artery and vein all together which makes shorter and safer operation.
Laparoscopic treatments for pancreatic disease have been also started. Benign pancreatic tumors which locate in body or tail of pancreas and pancreatic cyst are applicable for this surgery. Diagnostic laparoscopy with intraoperative tissue biopsy is also applied for pancreatic tumor disease.

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Laparoscopic surgery has been widely accepted as a one of the standard treatment. In urological field. Laparoscopic procedure has been becoming also common treatment for nephrectomy and adrenectomy. This type of treatment has advantages the same as the other laparoscopic surgery, such as minimally invasive surgery and early return to work. There are two different approaches with this procedure. One of these is transabdominal approach which is similar to the open surgery. The other is retroperitoneal approach, which is relatively newly developed. Both procedures have each advanteges and disadvantages. The indication for adrenectomy is still limited to benign diseses, but the indication for nephrectomy is extended to the malignant tumor of the kidney. Hand assisted surgery is also applied to laparoscopic nephrectomy which is able to shorten the operating time.

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In recent years laparoscopic surgery has come into wide use, yet it is not generally used for gynecological surgery. There may be two reasons for this:
1) Laparoscopic surgery requires specialized equipment and techniques.
2) Laparoscopic surgery, being two dimensional, introduces three dimensional perception problems and kinematic difficulties. The purpose of the current is to describe efficacious laparoscopic procedures for gynecological applications for the ovary and fallopian tube. For benign ovarian diseases Laparoscopic methods such as salpingo-oophorectomy, oophorectomy, ethanol infusion therapy, ovarian cystectomy and vaporization of polycystic ovary syndrome, are useful. For tubal tubal diseases, adhesiolysis, fimbrioplasty and salpingostomy for tubal infertility, are effective laparoscopic procedures. Finally, for ectopic pregnancy, salpigostomy and salpingectomy are in many cases the preferred surgical option.

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[in Japanese]

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The advantages of endoscopic axillary lymphnode resection are no incision of axillary deep pectoral fascia, no post operative axillary drawn, good recovery of shoulder joint movement, a slight pain for rehabilitation compared with conventional breast cancer operation. Postoperative axillary wound in not be conspicuous, and this procedure has possibility as reduce postoperative hospital days. Complication of this operation sometimes happened pneumohypoderma.
Conventional operation of any thyroid diseases have large skin incision of anterior cervical area, and operative scar are conspicuous places. But endoscopic thyroidectomy have complete covered operative scar with clothes. Complication of recurrence nerve injury will be able to prevent under endoscopic thyroidectomy. Because endoscopic thyroidectomy have a good magnified visualization. At present, this operations take a long time. Subject of endoscopic thyroidectomy is shortage of operation time.
Both of endoscopic surgery will be able to become short operation time and extend operative indication, if become proficient in technique, device of procedure, development of operative compliments.

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