Một trong những thách thức và thời gian diễn tập tiêu thụ là khâu. Trình điều khiển nội soi kim có 10, 5, và 3 kích cỡ mm. Một số những thách thức chung bao gồm khó khăn trong việc định hướng cây kim vào người lái xe | Chapter 19 Pediatric Endourology 325 One of the most challenging and time consuming maneuvers is suturing. Laparoscopic needle drivers come in 10 5 and 3 mm sizes. Some common challenges include difficulty orienting the needle on the driver as well as orienting the needle to the tissue. One device that can be helpful is a self-righting needle driver. Another potential tool is an automatic suturing device Endo-Stitch US Surgical Norwalk CT . However this requires larger suture material which leaves larger suture tracks. This is not suitable for most pediatric procedures. Hemostasis can be achieved in many ways. Electrocautery can be attached to most hand instruments. It is available in both monopolar and bipolar forms. Some prefer bipolar because the current does not pass through the entire body. This reduces the risk of burns distant from the forceps and decreases the depth of injury to adjacent tissue. Another option is harmonic ultrasonic energy. This cuts and coagulates tissue simultaneously at a lower temperature than electrocautery 50-100 C . The harmonic scalpel blade vibrates at 55 500 Hz and couples with protein to denature the tissue. Once denatured it forms a coagulum that seals small vessels 16 . Larger structures such as the renal vessels and ureter may require individual ligation. This can be done by tying a suture or applying an individual clip. The smallest clip applier currently available fits through a 5-mm port. If an anastomic stapler is needed the port must be at least 12 mm. General Laparoscopic Complications There are some inherent risks of laparoscopic surgery. In 1996 Peters et al. 7 performed a survey to assess complications in pediatric urological laparoscopy. The overall incidence was . The majority of these complications were CO2-related morbidities including preperitoneal insufflation and subcutaneous emphysema. The need for surgical repair of complications occurred in only . The rate of complications correlated with the level
