title: Use of 3 mm percutaneous instruments with 5 mm end effectors during different laparoscopic procedures.
abstract: OBJECTIVE
  With a recent focus on minimizing the visibility of scars, new techniques have been developed. Minilaparoscopy reemerged as an attractive option for surgery as it limits tissue trauma, reduces post-operative pain and improves cosmesis. This study was designed to describe our experience with percutaneous trocarless 3 mm instruments used in combination with standard 5 mm and 10 mm laparoscopic instruments in different general surgery procedures.
  
  
  METHODS
  We used the PSS (Percutaneous Surgical Set, Ethicon Endo surgery, Cincinnati, OH, USA) in different surgical procedures as accessory instruments in combination with standard 5 mm and 10 mm standard laparoscopic instruments.
  
  
  RESULTS
  The use of percutaneous instruments was safe and feasible in all performed procedures. The surgical technique was not modified. The percutaneous instruments can assure a good grip and can be used for traction and counter-traction. No complications have been described. No pain at the site of insertion has been reported. The skin, muscle and peritoneal defects were smaller than with the 3 mm laparoscopic traditional instruments.
  
  
  CONCLUSIONS
  Percutaneous approach seems to be a good option in general surgery in terms of efficiency, offering better cosmetic results and good pain control.
authors.affiliation: Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: David
authors.affiliation: Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.affiliation: Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.affiliation: Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cassinotti
authors.affiliation: Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.affiliation: Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rovera
authors.affiliation: Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Spampatti
authors.affiliation: Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Elisabetta Marta
authors.initials: EM
authors.lastname: Colombo
authors.affiliation: Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Dionigi
mesh_terms: D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications
keywords: Minimally invasive surgery; NOTES™; Percutaneous instruments; Single-port surgery