Controversies in Laparoscopic Surgery

)PUIL)[[ITQI 5QKPMT/IOVMZ 5W[PM;KPMQV -L[

#ONTROVERSIESIN,APAROSCOPIC3URGERY

)PUIL)[[ITQI 5QKPMT/IOVMZ 5W[PM;KPMQV -L[

#ONTROVERSIESIN ,APAROSCOPIC3URGERY    

!HMAD!SSALIA -$ ,MX]\a,QZMK\WZIVL+PQMNWN4IXIZW[KWXQK;MZ^QKM ,MXIZ\UMV\WN;]ZOMZa*:IUJIU0MIT\P+IZM+IUX][ 4MK\]ZMZQV;]ZOMZa QWTI\QWV[IZMTQIJTMNWZXZW[MK]\QWV]VLMZ\PM/MZUIV+WXaZQOP\4I_ 3PRINGER 6ERLAGISAPARTOF3PRINGER3CIENCE"USINESS-EDIA [XZQVOMZWVTQVMKWU ˆ;XZQVOMZ>MZTIO*MZTQV0MQLMTJMZO 8ZQV\MLQV/MZUIVa



*/WZ4);/*'  ?PQKP<MKPVQY]MNWZ>*/' 



+WV\MV\[

  

4IXIZW[KWXQK>MZ[][WXMV>*/  ;]UUIZa  :MNMZMVKM[ 

#OMMENTARY -L_IZL-5I[WV

+PIX\MZ 'ASTRIC"YPASSFOR-ORBID/BESITY   ,I^QL;WT]UMIVL4WOQ[\QK[ WN\PM7XMZI\QWV  ;]UUIZa!

86))

86))) +WV\MV\[



:MNMZMVKM[!

#OMMENTARY 8QKIZL5IZKMI]

+PIX\MZ #HOLECYSTECTOMY  +IZWT-0;KW\\+WVVMZ                       

1V\ZWL]K\QWV  ,Q[K][[QWV 1VLQKI\QWV[ )K]\MIVL/IVOZMVW][+PWTMKa[\Q\Q[ +WUUWV,]K\;\WVM[,QIOVW[Q[IVL5IVIOMUMV\ ! +QZZPW[Q[ ! 8ZMOVIVKa  ! /ITTJTILLMZ8WTaX[ 5IVIOMUMV\WN1VKQLMV\ITTa,Q[KW^MZML +IZKQVWUIWN\PM/ITTJTILLMZ +PWTMKa[\MK\WUa1VKQLMV\IT \W7\PMZ4IXIZW[KWXQK8ZWKML]ZM[  <MKPVQY]M   8ZWXPaTIK\QK)V\QJQW\QK[   /I[TM[[4IXIZW[KWXa   .M_MZ8WZ\[WZ;UITTMZ8WZ\[  =T\ZI[WVQK;KITXMT7\PMZ/ILOM\[  .]VL][.QZ[\,Q[[MK\QWV  7XMZI\Q^M+PWTIVOQWOZIXPa IVL4IXIZW[KWXQK=T\ZI[W]VL  7]\XI\QMV\+PWTMKa[\MK\WUa  ;]UUIZa :MNMZMVKM[ 

#OMMENTARY =TZQKP;KPÕNNMT

+PIX\MZ #HOLEDOCHOLITHIASIS   *QXIV+PIVL2MNNZMa8WV[Sa   

1V\ZWL]K\QWV   ,Q[K][[QWV  ?PMV;PW]TLI8ZMWXMZI\Q^M-:+8*M8MZNWZUML'

+WV\MV\[ 8)8



           

?PI\1V\ZIWXMZI\Q^M<MKPVQY]M[;PW]TL *M=\QTQbMLNWZ;\WVM:MUW^IT' 4IXIZW[KWXQKQZOQVQI+WUUWV_MIT\P=VQ^MZ[Q\a+PQMN ,Q^Q[QWVWN+=5MLQKIT+MV\MZ:QKPUWVL>QZOQVQI =;) 'LYN'*AMIESON -$ &2!#3 &!#3 MUIQT"+PZQ[JI\M[JZW_V[_WZL(ILMTIQLMML]I] 8ZWNM[[WZIVL+PIQZUIV,MXIZ\UMV\WN;]ZOMZa :WaIT)LMTIQLM0W[XQ\ITQK\WZQI0W[XQ\IT;Q\M 8QVM)^MV]M?M[\ 5WV\ZMIT9+0)) +IVILI 0IERRE !LAIN#LAVIEN -$ 0H$ &!#3 &2#3 MUIQT"KTI^QMV(KPQZ]VQbPKP 8ZWNM[[WZIVL+PIQZUIV ,Q^Q[QWVWN>Q[KMZITIVLQ[KMZIT;]ZOMZa,MXIZ\UMV\WN;]ZOMZa =VQ^MZ[Q\aWN.ZMQJ]ZO/MZUIVa IVL:ML+ZW[[0W[XQ\IT4QVLMVJMZO 2ÃOMZ[\Z 4QVLMVJMZO /MZUIVa 3EYMOUR)3CHWARTZ -$ MUIQT";MaUW]ZG;KP_IZ\b(=:5+:WKPM[\MZML] ,Q[\QVO]Q[PML)T]UVQ8ZWNM[[WZWN;]ZOMZa =VQ^MZ[Q\aWN:WKPM[\MZ;KPWWTWN5MLQKQVMIVL,MV\Q[\Za :WKPM[\MZ6A =;)

8,)6 4Q[\WN+WUUMV\I\WZ[

%DUARDO-4ARGARONA -$ 0H$ MUIQT"M\IZOIZWVI(P[X[IV\XI]M[ +PQMNWN;MK\QWVWN-VLW[KWXQK;]ZOMZa )[[WKQI\M8ZWNM[[WZWN;]ZOMZa;MZ^QKMWN;]ZOMZa 0W[XQ\ITLM;IV\8I] 5MLQKIT;KPWWTWN\PM)]\WVWUW][=VQ^MZ[Q\aWN*IZKMTWVI 8+TIZM\ *IZKMTWVI ;XIQV

-ANUEL4RIAS -$ 0H$ ,QZMK\WZWN\PM;MZ^QKMWN;]ZOMZa)[[WKQI\M8ZWNM[[WZWN;]ZOMZa 0W[XQ\ITLM;IV\8I] 5MLQKIT;KPWWTWN\PM=VQ^MZ[Q\aWN*IZKMTWVI 8+TIZM\ *IZKMTWVI ;XIQV *3TUART7OLF *R -$ MUIQT"_WTN[(]UQKPML] )[[WKQI\M8ZWNM[[WZWN=ZWTWOa,QZMK\WZ ,Q^Q[QWVWN5QVQUITTa1V^I[Q^M=ZWTWOa=VQ^MZ[Q\aWN5QKPQOIV ,MXIZ\UMV\WN=ZWTWOa-5MLQKIT+MV\MZ,Z )VV)ZJWZ51 ! =;) 3EN #HANG9U-$ 0H$ MUIQT"[MVKPIVO(PIUKV\]ML]\_ )[[WKQI\M8ZWNM[[WZ,MXIZ\UMV\WN;]ZOMZa 6I\QWVITMZM[[ VMMLTM7J[\M\/aVMKWT!!# " w  *aZWV2?5IZSMV[WV/5QaIbI_I3)ZIVLWUQbMLKWUXIZQ[WVWN>MZM[[VMMLTMIVL LQZMK\\ZWKIZQV[MZ\QWVNWZTIXIZW[KWXa;]ZO/aVMKWT7J[\M\!!#"!w   ;IV\ITI52IZ^MTI13I]XXQTI)MZM[[VMMLTMQVTIXIZW[ KWXaWNWJM[M[]JRMK\["IXZIK\QKITIT\MZVI\Q^M0]U:MXZWL!!!#"w  ! 5M\\TMZ41JZIPQU5>QVP>9M\IT+TQVQKITM`XMZQMVKM_Q\PIVWX\QKITIKKM[[\ZWKIZ QVOaVMKWTWOQKITTIXIZW[KWXaXMT^Q[KWXa2;WK4IXIZWMVLW[K;]ZO!!#"w  5IZKW^QKP:,MT<MZbW5)?WTN2;+WUXIZQ[WVWN\ZIV[XMZQ\WVMITTIXIZW[KWXQKIK KM[[\MKPVQY]M["7X\Q^QM_^Q[]ITQbQVO\ZWKIZIVL>MZM[[VMMLTM2-VLW]ZWT#"w !  ;\ZQVO)*MZJMZ-.WZW]\IVQ)M\IT=[MWN\PMWX\QKITIKKM[[\ZWKIZNWZ[INMIVLZIXQL MV\ZaQV^IZQW][TIXIZW[KWXQKXZWKML]ZM[;]ZO-VLW[K#"w  6I\ITQ 2 1UXTQKI\QWV[ UÈLQKWTÈOITM[ LM[ \ZI]UI\Q[UM[ ^I[K]TIQZM[ I] KW]Z[ LM TI KPQZ]ZOQM^QLÈWMVLW[KWXQY]M25IT>I[K!!#"w

#OMMENTARY 0IZZQ\P50I[[WV *]KS20WZ[\51VKZMI[M[QV QV\ZIIJLWUQVITXZM[[]ZMINNMK\X]TUWVIZaKWUXTQIVKM)ZKP;]ZO!!#"w  :QKPIZL[WV2,Q[\M)/ZWVO3;^IVM[30WZUWVIT KPIVOM[ ZMTI\ML \W ZML]KML ZMVIT JTWWL ãW_ IVL TW_ ]ZQVM W]\X]\ ]VLMZ XZWTWVOML QVKZMI[MLQV\ZIIJLWUQVITXZM[[]ZMQVXQO[-]Z2;]ZO# " w   *TWWUâMTL /4 *TWKPMZ +: .ISPZa 1. ;QKI ,) ;]OMZUIV 02 -TM^I\ML QV\ZIIJ LWUQVIT XZM[[]ZM QVKZMI[M[ XTI[UI ZMVQV IK\Q^Q\a IVL ITLW[\MZWVM TM^MT[ 2  -NâKIKa WN ZW]\QVM TIXIZW[KWXa NWZ \PM IK]\M IJLWUMV ;]ZO-VLW[K!! #"!w   ;IVVI ) )LIVQ /4 )VIVQI / M\ IT MZM[[ VMMLTM 2 -VLW]ZWT #"w!  ?WTN2;2Z4IXIZW[KWXQKIKKM[[_Q\PI^Q[]ITQbQVO\ZWKIZ<MKP=ZWT!!#"w  ;PIZX0M\IT.IK\WZ[I[[WKQI\ML_Q\PKWV^MZ[QWV\WTIXIZW\W UaQVXI\QMV\[]VLMZOWQVOTIXIZW[KWXQKIXXMVLMK\WUa2)U+WTT;]ZO#!"! w  ;KPZMVS 8 ?WQ[M\[KPTIOMZ : :QMOMZ : M\ IT ) LQIOVW[\QK [KWZM \W XZMLQK\ \PM LQN âK]T\a WN I TIXIZW[KWXQK KPWTMKa[\MK\WUa NZWU XZMWXMZI\Q^M ^IZQIJTM[ ;]ZO -VLW[K !! #" w  ;QSWZI;;3]UIZ);I`MVI:M\IT4IXIZW[KWXQKKPWTMKa[\MK\WUawKIVKWV^MZ[QWVJM XZMLQK\ML'?WZTL2;]ZO!!#!"  w  A];++PMV;+?IVO;5M\IT1[XZM^QW][IJLWUQVIT[]ZOMZaIKWV\ZIQVLQKI\QWV\W TIXIZW[KWXQKKPWTMKa[\MK\WUa'24IXIZWMVLW[K;]ZO!!#"w  0]\KPQV[WV+0WO\,);KPWJ7M\IT-NNMK\[WN+7XVM]UWXMZQ\WVM]UQVXZMOVIV\ M_M[2;]ZO:M[!!#"!w ! )T.WbIV04?I\[WV?2M\IT8MZQ\WVMITKa\WTWOaQV\PM[]ZOQKITM^IT]I\QWVWN OI[\ZQKKIZKQVWUI*Z2+IVKMZ!!!#!"w  .]RQ_IZIAITLMKI[I[2+,MTOILW;M\IT4IXIZW[KWXaI[[Q[\MLKWTMK\WUa^MZ [][WXMVKWTMK\WUaNWZ\ZMI\UMV\WNVWVUM\I[\I\QKKWTWVKIVKMZ"IZIVLWUQbML\ZQIT 4IVKM\#!"w!

#OMMENTARY ,I^QL5,MV\ IVSMQZ[JQTKS 2 ,IU[ ) M\ IT 4IXIZW[KWXQK ILR][\IJTM M[WXPIOWOI[\ZQK JIVLQVO"IXZMTQUQVIZaM`XMZQMVKM7JM[;]ZO!! # "!w

 2IKY]M[50QUXMV[<WU8>TM]OMT[  +IXQbbQ.,*W[KPQ;*Z]TI\\Q5M\IT4IXIZW[KWXQKILR][\IJTMM[WXPIOWOI[\ZQKJIVL QVO"XZMTQUQVIZaZM[]T\[7JM[;]ZO#"!w  ?MQ[[0/6MPWLI04IJMKS*M\ITQK\WZbWV5<WTWVMV81V\MZUMLQI\MZM[]T\[NWTTW_QVOTIXIZW[KWXQKILR][\IJTMOI[\ZQK JIVLQVONWZUWZJQLWJM[Q\a,QO;]ZO#!"w  1W^QVW 8 )VOZQ[IVQ 4 ITMV\M88Q[MV\+M\IT-I\QVOXI\\MZVQV\PMâZ[\aMIZNWTTW_QVOILR][\IJTM [QTQKWVMOI[\ZQKJIVLQVO);/*NWZUWZJQLWJM[Q\a1V\27JM[!!#"!w .WJQ54MM01O_M,.MTIPa*M\IT*IVLMZW[QWV"QVKQLMVKMM\QWTWOaUIVIOMUMV\ IVLW]\KWUMIN\MZJIVLML^MZ\QKITOI[\ZQKJaXI[[7JM[;]ZO#"!!w  ;bWTL ) )J])JMQL ; 4IXIZW[KWXQK ILR][\IJTM [QTQKWVM OI[\ZQK JIVLQVO NWZ UWZJQL WJM[Q\a"ZM[]T\[IVLKWUXTQKI\QWV[QVXI\QMV\[;]ZO-VLW[K#"w  5Q\\MZUIQZ :8 ?MQ[[ 0 6MPWLI 0 M\ IT =VKWUUWV QV\ZIOI[\ZQK UQOZI\QWV WN \PM ;_MLQ[PILR][\IJTMOI[\ZQKJIVL7JM[;]ZO#"w  +ITUM[ 25 *M\\[KPIZ\ > :INNW]T ? M\ IT *IVL QVNMK\QWV _Q\P [XTMVWXWZ\IT ^M VW][\PZWUJW[Q["IV]V][]ITJ]\[M^MZMKWUXTQKI\QWVWNOI[\ZQKJIVLQVO7JM[;]ZO #"!!w  6Q^QTTM-,IU[)>TI[[MTIMZ[24IX*IVLMZW[QWV"QVKQLMVKMIVL\ZMI\UMV\7JM[;]ZO #"w  ?MQ[[ 0 6MPWLI 0 4IJMKS * M\ IT /I[\ZW[KWXQK JIVL ZMUW^IT IN\MZ QV\ZIOI[\ZQK UQOZI\QWV WN ILR][\IJTM OI[\ZQK JIVL" I VM_ UQVQUIT QV^I[Q^M \MKPVQY]M 7JM[ ;]ZO #"w  ;QTMKKPQI/:M[\]KKQI)-TUWZM=M\IT4IXIZW[KWXQKILR][\IJTM[QTQKWVMOI[\ZQKJIVL QVO" XZW[XMK\Q^M M^IT]I\QWV WN QV\ZIOI[\ZQK UQOZI\QWV WN \PM TIXJIVL;]ZO 4IXIZW[K -VLW[K8MZK]\IV<MKP#"!w  )[Pa ): 5MZLIL ))) XZW[XMK\Q^M [\]La KWUXIZQVO ^MZ\QKIT JIVLML OI[\ZWXTI[\a ^MZ[][TIXIZW[KWXQKILR][\IJTMOI[\ZQKJIVLQVOQV\PM\ZMI\UMV\WNUWZJQLIVL[]XMZ WJM[Q\a1V\;]ZO!! # " w   *IT[QOMZ*58WOOQW245IQ2M\IT<MVIVLUWZMaMIZ[IN\MZ^MZ\QKITJIVLMLOI[\ZW XTI[\aI[XZQUIZaWXMZI\QWVNWZUWZJQLWJM[Q\a2/I[\ZWQV\M[\;]ZO#"! w ! :MV +2 0WZOIV ; 8WVKM 2 =; M`XMZQMVKM _Q\P \PM 4)8*)6, [a[\MU )U 2 ;]ZO # ";w;  -^IV[2,;KW\\50*ZW_V);M\IT4IXIZW[KWXQKILR][\IJTMOI[\ZQKJIVLQVONWZ\PM \ZMI\UMV\WNUWZJQLWJM[Q\a)U2;]ZO# "!w



+PIX\MZ )LR][\IJTM/I[\ZQK*IVLQVO4)/*NWZ5WZJQL7JM[Q\a 

 :]JQV5;XQ^IS08ZW[XMK\Q^M[\]LaWNXI\QMV\[]VLMZOWQVOTIXIZW[KWXQKOI[\ZQK JIVLQVO][QVO\PM\_W[\MX\MKPVQY]M"I\MKPVQY]M\WXZM^MV\XW[\WXMZI\Q^M[TQXXIOM ;]ZO-VLW[K#" w  +ILQÇZM /* 0QUXMV[ 2 0IQVI]` * M\ IT 4IXIZW[KWXQK ILR][\IJTM OI[\ZQK JIVLQVO ;MUQV4IXIZW[K;]ZO#!"w  :]JMV[\MQV:*4IXIZW[KWXQKILR][\IJTMOI[\ZQKJIVLQVOI\I=;KMV\MZ_Q\P]X\W aMIZNWTTW_]X7JM[;]ZO#" w  )J])JMQL;3MQLIZ)/I^MZ\6M\IT*/W]\KWUM[IX XMIZ\WJMKTMIZTa[]XMZQWZ\W\PW[MIKPQM^MLQV\PM=;)1VXIZ\QK]TIZIKKWZ LQVO\W\PMLI\IWN\PM1\ITQIV:MOQ[\ZaNWZ7JM[Q\a;]ZOMZaC EQV\PMTIXIZW [KWXQK5IK4MIVr[^MZ\QKITJIVLMLOI[\ZWXTI[\aKI[M[-?4_I[ I\ aMIZ[)KKWZLQVO\W\PM:MQVPWTLKTI[[QâKI\QWV  WN\PMXI\QMV\[I\aMIZ[ JMTWVOML \W \PM KTI[[M[ iM`KMTTMV\t IVL iOWWLt */)bIOZIIVLKWTTMIO]M[CENW]VL



 55WZQVW5<WXXQVW/5,MT/MVQW

VW LQNNMZMVKM[ MQ\PMZ _Q\P MIZTa IVL TI\M KWUXTQKI\QWV[ WZ ZM[]T\[ WN _MQOP\ TW[[7V\PMW\PMZPIVL\PMaVW\MLI[QOVQâKIV\LMKZMI[MQV\PMQVKQLMVKMWN _W]VLQVNMK\QWV[IVLTI\MZQVKQ[QWVITPMZVQI[ */ o
)KWUXTM\M[\IXTMTQVMLQ^Q[QWV[QOVQâKIV\TaZML]KM[TWVO\MZUNIQT]ZM[ o
4IXIZW[KWXQK>*/Q[[]XMZQWZ\WWXMV>*/ 2EFERENCES  5I[WV--,WPMZ\a+5IPMZ2?;KW\\,0:WLZQO]Mb-5*TWUUMZ[MZ\QKITJIVLMLOI[\ZWXTI[\aIVLOI[\ZQKJaXI[["TWVO\MZUZM[]T\[ 7JM[;]ZO!!#"w  .WJQ5)4>MZ\QKITJIVLMLOI[\ZWXTI[\a^[OI[\ZQKJaXI[["aMIZ[NWTTW_]X7JM[Q\a ;]ZO!!#"w  ;_MM\?)>MZ\QKITJIVLMLOI[\ZWXTI[\a"[\IJTM\ZMVL[QV_MQOP\KWV\ZWTI\WZUWZM aMIZ[7JM[Q\a;]ZO!!#"!w  <WXXQVW55WZQVW5+IX]bbQ85Q[\ZIVOMTW5+IZZMZI55WZQVW.7]\KWUMWN ^MZ\QKITJIVLMLOI[\ZWXTI[\a7JM[;]ZO!!!#!"w  5I[WV--/I[\ZQK[]ZOMZaNWZUWZJQLWJM[Q\a;]ZO+TQV6WZ\P)U!!#"w   <WXXQVW56QOZI17TQ^QMZQ.5]ZI\WZM)*W[QW+)^IOVWVI;;\IXTMTQVMLQ[\Z]X\Q WV[QV^MZ\QKITJIVLMLOI[\ZWXTI[\aZMTI\ML\WLQNNMZMV\[\IXTQVO\MKPVQY]M[7JM[;]ZO !!#"w ! ;^MVPMLMV3-)SM[[WV4)0WTULIPT+6I[T]VL1;\IXTMLQ[Z]X\QWVQV^MZ\QKITJIV LMLOI[\ZWXTI[\a7JM[;]ZO!!#"w   +IUX[5BMZ^W[-/WWLM;-M\IT,WM[QVILMY]I\M_MQOP\TW[[NWTTW_QVOJIZQI\ZQK []ZOMZaXZMLQK\[\IXTMTQVMNIQT]ZM')XZW[XMK\Q^M[\]La7JM[;]ZO!!#"w  5MTQ[[I[2+PZQ[\WLW]TISQ[5;KPWZM\[IVQ\Q[/0IZWKWXW[/LM*ZMM-/ZIUI\QSISQ[ 2IVPI^MZJMMS 5 ,M^]a[\ 4 ;Y]MTI MZ\ 2 4IXIZW[KWXQK OI[\ZQK ZML]K\QWV []ZOMZa 8ZMTQUQVIZa ZM[]T\[ WN I ZIVLWUQbML XZW[XMK\Q^M \ZQIT WN TIXIZW[KWXQK ^[ WXMV ^MZ\QKIT JIVLML OI[\ZWXTI[\a ;]ZO -VLW[K !!!#"w   0W_IZL45ITWVM55QKPITMS)+IZ\MZ2)TOMZ;>IV?WMZ\2/I[\ZQK*aXI[[IVL >MZ\QKIT*IVLML/I[\ZWXTI[\awIXZW[XMK\Q^MZIVLWUQbMLKWUXIZQ[WVIVLaMIZNWT TW_]X7JM[;]ZO!!#"w  ;]ZOMZUIV02;\IZSMa2>*QZSMVPI]MZ:)ZIVLWUQbMLXZW[XMK\Q^M\ZQITWN/I[\ZQK *aXI[[ ^MZ[][ >MZ\QKIT *IVLML /I[\ZWXTI[\a NWZ UWZJQL WJM[Q\a IVL \PMQZ MNNMK\[ WV [_MM\^MZ[][VWV[_MM\MI\MZ[)VV;]ZO! #"w   5IK4MIV4,:PWLM*5.WZ[M:)6WPZ+;]ZOMZaNWZWJM[Q\a)V]XLI\MWNIZIVLW UQbML\ZQIT7JM[;]ZO!!#"w ! 1[IK[[WV).ZMLMZQS[MV;/6QT[[WV80MLMVJZW249]ITQ\aWNTQNMIN\MZOI[\ZWXTI[\aQ[ VWZUIT"IKWV\ZWTTML[\]La-]Z2;]ZO!!#" w  /]Q[ILW2)>Ib.2)TIZKWV24WXMb1JWZ222Z:]JQW5)/IQ\M48[aKPWXI\PWTWOQKIT [\I\][IVLQV\MZXMZ[WVITN]VK\QWVQVONWTTW_QVO_MQOP\TW[[QVUWZJQLTaWJM[MXI\QMV\[ ]VLMZOWQVOJIZQI\ZQK[]ZOMZa7JM[;]ZO#" w  8IXIOMWZOQW]/58IXISWV[\IV\QVW])5IUXTMSW]-<MZbQ[15MTQ[[I[28ZMIVL XW[\WXMZI\Q^M X[aKPWTWOQKIT KPIZIK\MZQ[\QK[ QV UWZJQLTa WJM[M XI\QMV\[ 7JM[ ;]ZO #"w!



 55WZQVW5<WXXQVW/5,MT/MVQW  *IT\I[IZ)*W]:)ZTIVLQ[.5IZ\QVMb:;MZZI+*MVOWKPMI55QZÑ2>MZ\QKITJIV LMLOI[\ZWXTI[\aI\UWZM\PIVaMIZ[7JM[;]ZO!! # "!w  ;PIQ10MVSQVA?MQ\bUIV;4M^Q14WVO\MZULQM\IZaKPIVOM[IN\MZ^MZ\QKITJIVLML OI[\ZWXTI[\a"Q[\PM\ZILMWNNNI^WZIJTM'7JM[;]ZO#" w  ?a[[+4I]ZMV\2IKIZL)*]ZKSPIZL\82IaM\)/IbbWTI44WVO\MZUZM[]T\[WVY]I TQ\aWNTQNMWN[]ZOQKIT\ZMI\UMV\WNWJM[Q\a_Q\P^MZ\QKITJIVLMLOI[\ZWXTI[\a7JM[;]ZO !!#" w!  ;IJJQWVQ5-,QKS[WV50-aKPU]TTMZ;.ZIVSM,/WMb;0]ZVa+6IMN5*IT[QOMZ *LM5IZKW,*]ZOQ=*]KPMTMZ5?1V\MZUMLQI\MZM[]T\[WNPMIT\PZMTI\MLY]ITQ\aWN TQNMIN\MZ^MZ\QKITJIVLMLOI[\ZWXTI[\a1V\27JM[:MTI\5M\IJ,Q[WZL#"w   0MTT-5QTTMZ3)5WWZMPMIL536WZUIV[;-^IT]I\QWVWNPMIT\P[\I\][IVLY]ITQ\a WNTQNMIN\MZJIZQI\ZQK[]ZOMZa"KWUXIZQ[WVWN[\IVLIZL:W]`MVAOI[\ZQKJaXI[[^MZ \QKITJIVLMLOI[\ZWXTI[\aIVLTIXIZW[KWXQKILR][\IJTM[QTQKWVMOI[\ZQKJIVLQVO7JM[ ;]ZO#"w!  )TTM248WWZ\UIU+PMTITI-.Q^MaMIZ[M`XMZQMVKM_Q\PTIXIZW[KWXQK^MZ\QKITJIVLML OI[\ZWXTI[\a7JM[;]ZO!! # "w   <WXXQVW55WZQVW.5WZQVW5:MOQ[\Za+WV\ZQJ]\WZ[1\ITQIV:MOQ[\ZaNWZJIZQI\ZQK []ZOMZa"LI\I]X\WaMIZ[C)J[\ZIK\E7JM[;]ZO#"! ! 5IK4MIV4,:PWLM*5;IUXITQ[2M\IT:M[]T\[WN\PM[]ZOQKIT\ZMI\UMV\WNWJM[Q\a )U2;]ZO!!#"w  8MSSIZQVMV+PZQ[\W] >>1WZ>111LQIUM\MZTM[[\PIV KUIVLVWM^QLMVKMWNQVNMK\QWVWZKITKQâKI\QWVCE)^VQA;PQUWVW^5.ZQMLUIV>:W[MV)+bMZVQIS)111XZM[MV\\MKPVQKIT

 ;MTÆ]S5MZKIV

KPITTMVOM[L]M\WLQNâK]T\M`XW[]ZM)T\PW]OPNMVM[\ZI\QWVWNKa[\[QV\PM[M [MOUMV\[Q[XW[[QJTMQ\UIaJMI[[WKQI\ML_Q\PQVKWUXTM\MKa[\_ITTZM[MK\QWV UISQVO\PMUXZWVM\WZMK]ZZMVKM *MNWZMKWUXTM\QWVWN\PMWXMZI\QWVXI\PWTWOQKM`IUQVI\QWV[PW]TLJMWJ \IQVML\WZ]TMW]\\PMXZM[MVKMWNKa[\ILMVWUI,Q[KW^MZaWNIKa[\ILMVWUI VMKM[[Q\I\M[KWUXTM\MM`KQ[QWV_PQKPUIaZMY]QZMWXMVZM[MK\QWV *MNWZM\PMIL^MV\WNTIXIZW[KWXQK[]ZOMZaWXMVNMVM[\ZI\QWV_I[\PMOWTL [\IVLIZL NWZ \PM \ZMI\UMV\ WN [QUXTM Ka[\[ :MKMV\ [\]LQM[ PI^M [PW_V \PQ[ IXXZWIKP\WPI^MIPQOPMZUWZJQLQ\a_Q\PZMK]ZZMVKMZI\M[MY]Q^ITMV\\W\PM TIXIZW[KWXQK IXXZWIKP 0W_M^MZ WXMV []ZOMZa Q[ [\QTT QVLQKI\ML NWZ [WUM XW[\MZQWZKa[\[_PMZM\PMZMQ[QVIJQTQ\a\WM`KT]LMUITQOVIVKaIVLWXMZI\WZ QVM`XMZQMVKM_Q\PIL^IVKMLTIXIZW[KWXQK\MKPVQY]M[1V[]UUIZa\PMOZMI\ UIRWZQ\aWN[QUXTMKa[\[IZMJM[\IXXZWIKPML^QI\PMTIXIZW[KWXQKIXXZWIKP (YDATID#YSTSOFTHE,IVER ?PQTM]VKWUUWVQV6WZ\P)UMZQKIPMXI\WJQTQIZa[]ZOMWV[QVMVLMUQK ZMOQWV[ PI^M LM^MTWXML ZMUIZSIJTM M`XMZ\Q[M _Q\P \PQ[ KPITTMVOQVO LQ[MI[M .WZKa[\[\PI\IZMã]QLâTTML_Q\PLM\IKPMLMVLWKa[\J]\_Q\PW]\LI]OP\MZ Ka[\[XMZK]\IVMW][I[XQZI\QWVIVL[\MZQTQbI\QWVPI[JMMVZMKWUUMVLMLITMZQ)*WZZMTTQ)8ZM[MV\Q4M\IT)LZMVITUI[[M[QVVMWXTI[\QKXI\QMV\[)ZWTMWN TIXIZW[KWXQKXZWKML]ZM;]ZO-VLW[K#"!w 3MJMJM_-;QXMZ[\MQV)-+TIZS70M\IT:M[]T\[WNTIXIZW[KWXQKILZMVITMK\WUaNWZ [][XMK\ML IVL ]V[][XMK\ML UITQOVIV\ ILZMVIT VMWXTI[U[ )ZKP ;]ZO #"! w ! >I[[QTWXW]TW];MTTQV:;KP]T\b86)LZMVWKWZ\QKITKIZKQVWUI"KTQVQKITW]\KWUMI\\PM MVLWN\PM\PKMV\]Za+IVKMZ#!"w /QTT1;? 4IXIZW[KWXQK ZM[\WZI\Q^M XZWK\WKWTMK\WUa" KI[MUI\KPML KWUXIZI\Q^M [\]La_Q\PWXMVZM[\WZI\Q^MXZWK\WKWTMK\WUa,Q[+WTWV:MK\]U#"w   *ZIOI5>QOVITQ)/QIVW\\Q4B]TQIVQ?:ILIMTTQ//Z]IZQV8,MTTIJWVI8,Q+IZTW >4IXIZW[KWXQK^MZ[][WXMVKWTWZMK\IT[]ZOMZa"IZIVLWUQbML\ZQITWV[PWZ\\MZUW]\ KWUM)VV;]ZO#"!w   ;WTWUWV 52 AW]VO +2 -aMZ[ )) :WJMZ\[ :) :IVLWUQbMLKTQVQKIT\ZQITWNTIXIZW [KWXQK^MZ[][WXMVIJLWUQVITZMK\WXM`aNWZZMK\ITXZWTIX[M*Z2;]ZO# !"w! ! /IZJ][2-8W\MV\Q.?M`VMZ;,+]ZZMV\KWV\ZW^MZ[QM[QVXW]KP[]ZOMZa;W]\P5ML 2#!"w  ;KPUQ\\;4+WPMV;5?M`VMZ;,6WO]MZI[222IOMTUIV,/,WM[TIXIZW[KWXQKI[ [Q[\MLQTMITXW]KPIVITIVI[\WUW[Q[ZML]KM\PMTMVO\PWNPW[XQ\ITQbI\QWV'1V\2+WTWZMK \IT,Q[!!#!"w  ,_Q^MLQ)+PIPQV.)OZI_IT;+PI]?A<WW\TI)<WW\TI.;QT^IA24IXIZW[KWX QKKWTMK\WUa^[WXMVKWTMK\WUaNWZ[QOUWQLLQ^MZ\QK]TIZLQ[MI[M,Q[+WTWV:MK\]U #"!w  )TM`IVLMZ:22IY]M[*+5Q\KPMTT3/4IXIZW[KWXQKITTaI[[Q[\MLKWTMK\WUaIVL_W]VL ZMK]ZZMVKM4IVKM\!!#"!w  *MZMVL[.23IbMUQMZ/*WVRMZ024IVOM2.;]JK]\IVMW][UM\I[\I[M[IN\MZTIXIZW [KWXQKKWTMK\WUa4IVKM\!!#"   4IKa)5/IZKQI>ITLMKI[I[2+,MTOILW;+I[\MTT[)Q[I24IXI ZW[KWXaI[[Q[\ML KWTMK\WUa ^MZ[][ WXMV KWTMK\WUa NWZ \ZMI\UMV\ WN VWVUM\I[\I\QK KWTWVKIVKMZ"IZIVLWUQ[ML\ZQIT4IVKM\#!"w!  0IbMJZWMS-2#+747:;\]La/ZW]X+747:"IZIVLWUQbMLKTQVQKIT\ZQITKWUXIZQVO TIXIZW[KWXQKIVLWXMVZM[MK\QWVNWZKWTWVKIVKMZ;]ZO-VLW[K#"!!w  ?MMS[2+6MT[WV0/MTJMZ;;IZOMV\,;KPZWMLMZ/#+TQVQKIT7]\KWUM[WN;]ZOQ KITIZOQ[PMZPIMOM8,MTI\\ZM2IV;\MMV[MT+2*WMTPW]_MZ:=+TM^MZ[/25MQRMZ?; ;\I[[MV48;>MV\M28?MLMUI?.;KPZQR^MZ[)28>IV>ZWWVPW^MZV 3TQVOM = 8ZW[\PM\QK QUXTIV\[ NWZ PMZVQI ZMXIQZ *Z 2 ;]ZO #!" w   >WaTM[+:<MV[QWVNZMMUM[PXT]OPMZVQWXTI[\a7X<MKP/MV;]ZO!!!#"!w  ;ITKMLW?I[QKMS5,