Access for Laparoendoscopic Single Site Surgery

Laparoscopic surgery is the standard of care for many abdominal and pelvic operations and is widely applied today. LESS (Laparo-Endoscopic Single Site) surgery, originally attempted in the 1990s, is an advanced minimally invasive approach that allows laparoscopic operations to be undertaken through a small (<15 mm) incision in the umbilicus, a preexisting scar. The presence of a preexisting scar allows LESS surgery to be essentially scarless, which is the key benefit to LESS operations. Herein, we review our experience with over 500 LESS operations and discuss the key techniques to establishing access to the peritoneal cavity. We review the options for obtaining access, available instrumentation, common challenges and solutions for access. We conclude that LESS surgery is safe and provides outcomes with superior cosmesis relative to conventional laparoscopy. LESS surgery should be embraced, as patient demand is rapidly increasing

Endoscopic overtube

An over-tube was developed for receiving and guiding endoscopic instruments into a patient\u27s anus, through the colon, and into the peritoneum. The over-tube has a flexible sheath adapted for insertion into the anus through the colon and out the peritoneum of a patient. A stiffened region is used to protect the colonic wall from injury during insertion of medical instruments through the patient\u27s lower gastrointestinal tract. The proximal end of the over-tube is surrounded by two narrow inflatable balloons on either side of the colotomy to keep the device in place with its lumen open into the peritoneum and further prevent leakage of insufflation. The device may comprise two channels, one for duel channel endoscopes and larger medical instruments or single lumen endoscopes, and an additional channel for surgical instruments. A distal valve prevents insufflation leakage, making the device especially useful in NOTES surgeries

General surgery career resource.

General surgery residency training can lead to a rewarding career in general surgery and serve as the foundation for careers in several surgical subspecialties. It offers broad-based training with exposure to the cognitive and technical aspects of several surgical specialties and prepares graduating residents for a wide range of career paths. This career development resource discusses the training aspects of general surgery