Since early 1999, we have implemented a standardized technique for laparoscopic appendectomy, which is simple, safe and easily learned and mastered by our residents. Besides superior ergonomics, it offers cosmetic advantages. It is inexpensive as only reusable instruments are used. It incorporates useful modifications, such as the use of suprapubic ports, inferior approach with repositioning of the videoscope from the umbilical port to the left suprapubic port, laparoscopic gauze swabs and instrument-assisted knotting, as well as skeletonization of the appendix. We analyze the outcome of this technique between January 2000 and December 2002. The overall conversion rate of 713 laparoscopic appendectomies was 8.7%, which is comparable with the "best" rates in international literature. Operative times (mean, 59.0 minutes) and the complication rate (6.7%) compared favorably with previous reports on resident training. In summary, our residents feel comfortable with our standardized approach, while producing acceptable results with low cost.

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Objective: To evaluate and audit the safety and efficacy of ultrasound guided ethanol ablation for the treatment of benign thyroid cystic nodules with pressure and cosmetic symptoms.Methods: Retrospective case series from November 2018 to March 2021 with patients presented with symptomatic benign cystic thyroid nodules and treated with ethanol ablation. The major clinical outcomes were 6-month volume reduction rate and improvement in pressure symptom score and cosmetic symptom score. All complications were evaluated.Results: We studied thirty-seven consecutive cases with symptomatic benign thyroid cystic nodules. All cystic nodules were confirmed by FNAC to be benign. Seven out of thirty-seven cases received two sessions of ethanol ablation. The initial mean volume of cystic nodules was 17.93 ml (range 1.11 ml-60.01 ml). The mean volume of ethanol injected was 3.54 ml (range 0.5 ml-10.0 ml). The mean volume at 6-month post ablation was 4.48 ml (range 0 ml-60.15 ml). The mean volume reduction rate at 6-month post ablation was 80.46%. The median procedure time was 15 minutes.Adverse events were noted in three cases including transient pain and haematoma.The mean pressure symptom score improved from 4.48 (pre-ablation)(range 0-10) to 1.20 (post-ablation)(range 0-5). The mean cosmetic symptom score improved from 3.45 (pre-ablation) (range 1-4) to 1.37 (post-ablation)(range 1-3). There was one case with salvage hemithyroidectomy arranged. Conclusion:Ultrasound guided ethanol ablation is a safe and feasible treatment for symptomatic benign thyroid cystic nodules in terms of volume reduction and symptomatic relief, it serves as an alternative to surgical resection.