Unchanged for more than half a century, the World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Laparoscopic surgery has successfully managed the physical aspect of disease, enhanced mental well-being by its aesthetic virtues and by being less painful, and enhanced the social value by enabling early resumption of normal activity profile. The ongoing evolution of this revolutionary technique keeps bettering outcomes on all parameters. Surgical outcomes are the primary determinant of patient satisfaction [1]. Surgery leaves a scar not only on the body but on the mind as well [2]. Avoiding disruption of a tattoo is a welcome development that is sure to enhance the mental and psychosocial well-being of our patients [3]. The laparoscopic surgeon has continued to challenge his best outputs in a precise pursuit for perfection to better the best. Laparoscopic surgeons, who were ostracized in the early 1990s and called names such as ‘‘boys with toys’’ nearly killing their patients and disparagers married to ‘‘Nintendo surgery,’’ have come a long way to become the envy of once hostile brotherhood [4]. Consorting technology, laparoscopic surgeons have never failed to question and reshape themselves holistically with ever-evolving paradigms. Rising like a Phoenix from a breed of dying species, the laparoscopic surgeon has evolved with a larger canvas, the description of which goes by various names, i.e., cyber surgeon, endosurgeon, space surgeon, molecular surgeon, or biosurgeon [5]. This progress has been nurtured and sustained by societies, such as The Society of American Gastrointestinal and Endoscopic Surgeons and The European Association for Endoscopic Surgery, and above all by the Journal of Surgical Endoscopy. Surgery is a craft no different than art, because both of them are the result of some imitation and some variation [6]. Most renaissance intellectuals, including Leonardo da Vinci, had a common source of inspiration, as is the case with the biomedical scientists and the endosurgeon, the ambassador of the marriage of a craft with the art [6]. Surgical endoscopy is the common thread for all the good work that has contributed to the present status leading to improved patientperceived outcomes on physical, social, and mental parameters. Avoidance of tattoo disruption is one such benefit of laparoscopic surgery [3]. It not only preserves the tattoo but also the basic tenets of informed consent. It preempts the fiducial, coercive moments in the communication for an informed consent. Tattoos have adorned humankind for more than 5,000 years. Despite ridicule from orthodoxy (‘‘Ye shall not make any cuttings in your flesh for the dead, nor print any marks upon you’’ Leviticus 19:28), tattoos have gained social acceptance as status symbols, declaration of love/ sensuality/sexuality, or signs of religious beliefs. Tattoos, seen as a trivial appendage by some have become a fashion statement of visual expression of individuality to be seen as an extension of the wearer’s personality. Tattoos occupy the grey zone between virtue and vice on the perceptive social horizon. They evoke a potpourri of imagery in different souls, from sensual to intellectual to medicinal. It is something like the image of an apple that reminds us of either Eve or Newton or an iPod or simply the goodness of the fruit. It is in this light that the article by Gilliam et al. B. B. Agarwal (&) Dr. Agarwal’s Surgery & Yoga, F81 & 82, Street No. 4, Virender Nagar, New Delhi 10058, India e-mail: endosurgeon@gmail.com
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