Quarters and quavers

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Possible Answers: NOTES.

Random information on the term “NOTES”:

Single-port laparoscopy (SPL), also known as single-port access surgery (SPA), single-port incisionless conventional equipment-utilizing surgery (SPICES), single-incision laparoscopic surgery (SILS), Single-access endoscopic surgery (SAES), laparo-endoscopic single-site surgery (LESS), natural-orifice transumbilical surgery (NOTUS), and one-port umbilical surgery (OPUS), is a recently developed technique in laparoscopic surgery. It is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. Unlike a traditional multi-port laparoscopic approach, SPL leaves only a single small scar.

SPL is accomplished through a single 20 mm incision in the navel (umbilicus or belly button), or through only a 11 mm incision in the navel, minimizing the scarring and incisional pain associated with the multiple points of entry used during traditional laparoscopic surgery.


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Specialized equipment for SPL surgery falls into two broad categories; access ports and hand instruments. There are a number of different access ports, including GelPOINT system from Applied Medical, the SILS device from Covidien, the TriPort+, TriPort15 and QuadPort+ a from Advanced Surgical Concepts and the Uni-X from Pnavel. Hand instruments come in three configurations – standard, articulating, and pre-bent rigid. Standard hand instruments are rigid in design and were developed over the last 30 years for use in laparoscopy. Articulation is designed to overcome one of the challenges inherent in SPL, decreased triangulation of instrument. A number of factors influence a surgeon’s decision to use standard or articulating hand instruments, including which access port they use, their own surgical skills and cost as articulating instruments are significantly more expensive than standard instruments.[citation needed] SPL is enhanced by the use of specialized medical devices such as the SILS Multiple Instrument Access Port manufactured by Covidien and Laparo-Angle Articulating Instruments made by Cambridge Endoscopic Devices, Inc. The flexible port that can be fitted through a small incision in the navel to allow surgeons to use up to three laparoscopic devices simultaneously. Certain articulating instruments can be inserted through such specialized ports, providing surgeons with maneuverability and access to the target tissue from a single access point. However single port laparoscopic appendicectomy has also been performed using a single standard 10 mm “Y” shaped operating telescope having a 5 mm instruments channel also.

NOTES on Wikipedia