Therapeutic, IV.

We have seen substantial changes in minimally invasive surgery since its development in the early 1900s. Over the past 10 years, the addition of natural orifice transluminal endoscopic surgery and robotics has turned our attention to improved cosmesis and advancements in instrumentation. We have developed a new technique-single port access (SPA) surgery-and have applied it to the cholecystectomy. In this paper, we present and review the application of this access technique to the first 5 consecutive patients that underwent an SPA cholecystectomy. All 5 patients were female, with an average age of 45 years and an average weight of 172 pounds. Indications included biliary dyskinesia and symptomatic cholelithiasis. Average operative time was 121 minutes in these initial 5 cases. All but 1 patient was discharged in 24 hours. At 6 months, no umbilical hernias were observed. This new technique allows for a complete cholecystectomy to be performed entirely through the umbilicus without the need for additional retraction sites or transabdominal sutures. This procedure utilizes the same basic technique of the laparoscopic cholecystectomy already employed by general surgeons. Therefore, the SPA cholecystectomy can be readily learned and performed by many surgeons without the need for expensive or experimental equipment. Using a single portal of entry to the abdominal cavity, the umbilicus, cosmesis, and scar reduction is achieved.

Therapeutic, III.

Therapeutic, IV.

The authors conclude that single port access cholecystectomy is a viable alternative to multi-port cholecystectomy.

separate table. If we don't join the other participants, we fire, utilities, and law enforcement agencies on the one will perpetuate a disjointed response, resulting in sepa-hand, and the immediate-and long-term mass popularate, isolated activities by EMS, hospitals, and municipal tion health and social service concerns on the other.

We describe the development of a 2-day training curriculum in emergency public health to improve the competency of public health personnel to prepare for, and respond to, both natural and human-caused disaster hazards. The training is conducted in a face-to-face setting and content is mapped to recognized emergency preparedness competencies for public health workers. The training materials are uniquely structured to the specific hazards, demographics, resources, and local emergency response agencies for each jurisdiction. This training program incorporates a series of challenging interactive scenarios that reinforce decision making in a public health emergency. Pretesting and posttesting are used to evaluate knowledge gained by participants. This interactive approach aligns with the principles of adult learning, and training evaluations indicate that this method is an effective integration of process and content.

We present the first series of five SPA gastric tube placements, offering a viable alternative to PEG or open placement.