Another obstacle is the loss of instrument triangulation

Another obstacle is the loss of instrument triangulation and crowding of instruments. Newer articulating instruments offer a better solution to the aforementioned problems. However, crossing manipulation of these articulating instruments is counterintuitive and these articulating instruments are structurally less durable than conventional instruments. After gaining experience with more than 100 LESS procedures with the same LESS platform (homemade single-port, 30 degree endoscopy and conventional laparoscopic instruments), the instrument triangulation and clashing problems now rarely hinder our LESS procedures, by using the following tips. Firstly, with both hand instruments proceeding to the dissection and traction in rotation, the “sword fighting” of instruments can usually be avoided in most circumstances. Secondly, the instrument for tissue traction and the instrument for dissection should be placed in two different positions or directions, to prevent the instruments from clashing with each other. Thirdly, for successful intracorporeal suturing and knotting, the instrument triangulation is critically important. Thus, the laparoscope has to be positioned between instruments set on both sides to keep the mini-triangulation. In addition, the curved-tip needle holder and dissectors will provide more room and angle in suturing and knotting under our LESS platform. Although the aforementioned LESS techniques take time to learn and practice, it Aminoallyl-UTP is useful to meet the challenges by using conventional instruments in LESS. Our LESS platform has the following valuable features: (1) the average increased expenses on LESS consumables (US$79.8/procedure) are minimal. (Table 2); (2) the primary access of our LESS is always performed by an open technique, thus LESS is much safer than conventional laparoscopy using a Veress needle for primary access. The extra-expense on Veress needle can therefore be eliminated; (3) in LESS adrenalectomy, three trocars on a homemade port are usually sufficient in our retroperitoneal approach, hence the extra-expense on the fourth or fifth trocar, which is commonly used in conventional laparoscopic adrenalectomy, can be saved; and (4) with the currently described LESS technique, further expenses on newer articulating instruments and flexible endoscopic systems are rarely necessary when a standard laparoscopic system and instruments are already available. Though the clinical advantages of LESS over conventional laparoscopic procedures are still under investigation, with our LESS platform, LESS would in all probability be as cost-effective as conventional laparoscopic surgery.
Introduction Pediatric surgeons (PS) are specialists in surgical fields. Unfortunately, entropy is not always possible to have PS in all regional hospitals. Previous studies revealed improved outcomes for surgeries performed by associated surgical specialists. Similarly, a number of studies suggest that pediatric surgeries had a better outcome when under the care of PS. This study is the first attempt in this country to illustrate the effect of the participation of a PS on other surgical subspecialists in a regional hospital. Here, we will present our findings on an analysis of the distribution of pediatric surgeries in a regional hospital with and without a PS and an evaluation of the effect of a PS in a regional hospital.
Methods We collected data from all pediatric patients (<15 years old) who underwent surgical interventions in Cheng Ching hospital between December 2002 and November 2004. Cheng Ching hospital, a regional hospital, has all surgical specialists with the exception of a PS. The first author of this work has been working in Cheng Ching hospital since December 2003. We divided cases into group I (December 2002 to November 2003) and group II (December 2003 to November 2004). The types of surgeries and subspecialty trainings of surgeons were recorded. Surgeries that could not be commonly performed by PS (e.g., cardiovascular surgery, orthopedic surgery and neurosurgery) were excluded. The Chi-square test was used for frequencies and Student t test was used for continuous variables.