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SURGICAL TECHNOLOGY
icant learning curve. One fundamental skill involves lining up the
tools in use to prevent crowding and clashing at the surgical site
inside, says Sharona B. Ross, MD, director of minimally invasive
surgery and surgical endoscopy at Florida Hospital's Southeastern
Center for Digestive Disorders and Pancreatic Cancer, Advanced
Minimally Invasive and Robotic Surgery in Tampa. This can prove
particularly challenging at the intersection of instrumentation and
visualization.
"We use 5mm deflectable tip laparoscopes," she says, which can be
laid flat, yet still view another angle on demand. "Can you do singleincision with a rigid scope? Yes, you can, but then you can't move the
other instruments out of the way."
What could be better than a scope that circumvents traffic at the
site? Well, three-dimensional imaging would be, and the past year has
seen the introduction of a 3D laparoscope with a deflectable tip, but
it's a 10mm scope, which is too wide of an instrument for single-incision operations. "If you need that and a stapler, there's not enough
room in the port," says Dr. Ross.
Safety in sight
In the big picture, the surgeon who performs laparoscopic procedures
through a single incision must remain focused on patient safety. It is
not, after all, a shortcut procedure. "It's not how we get in that's most
important," says Dr. Ponsky, "it's what we do when we get there.
When we take out an organ, we want to do it safely."
Paul Curcillo II, MD, FACS, agrees, noting that the single-incision
method lends itself to clinical caution in trained hands. "One of the
biggest improvements of single-port access has been that we've rerecognized the importance of the critical view," says the director of
minimally invasive surgical initiatives and development at Fox Chase
Cancer Center in Philadelphia. "You're maintaining safety, seeing what
D E C E M B E R 2013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E
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