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 .