Initially Olympus TriPort ports were utilized, but this was changed things to Covidien SILS port for two reasons: firstly, standardization of consumable procurement within the department and secondly, an improved gas seal provide by the latter. This change was cost-neutral. Generally costs for the SILS approach were contained by the use of standard, reusable laparoscopic instruments [8]. Instrument clash is a challenge with straight devices, but the difficulties are not insurmountable and all operations were completed without conversion [9]. Clearly roticulating and curved instruments or even magnetic graspers while improving ergonomics and maneuverability when used with SILS, require practice to master and involve significant additional costs [9, 10]. Hansen et al.

[11], in his series of 224 SILS in children, reported at least 21% of operations requiring one additional port even for commonly performed operations like appendicectomy. In our series, none of the SILS cases required additional ports. Although not the subject of this study, it is possible that there are other indirect cost benefits of the SILS approach, namely, an improved pain experience and thus analgesic usage from the use of fewer ports and cost savings from earlier hospital discharge. Additionally, there are clear benefits to the national economy from earlier return to work. In conclusion, SILS appears to be cost-effective and safe for common pediatric surgical operations. There are no significant differences in operating time compared to standard laparoscopy in this series, but we are limited by a small sample size.

Studies with larger numbers will be necessary to validate these initial observations.
Surgery to correct adult spinal deformity (ASD) is a growing field. The ever-aging American population is presenting to spinal surgeons increasingly with high expectations of continued quality of life well into the seventh, eighth, and ninth decades of life. However, while surgical treatment of ASD is the only viable option for Batimastat patients failing conservative measures, the surgical interventions are associated with relatively high morbidity and mortality rates. Indeed, in a series reported from Johns’ Hopkins consisting of 361 patients, the 30-day mortality rate was found to be 2.4% [1]. In a more series by Smith et al., multicenter data from the Spinal Deformity Study Group demonstrated that even in expert centers 26.2% of patients suffered a minor complication and 15.5% suffered a major complication [2]. Several factors contribute to these high complication rates, including reduced bone mass and weaker fixation points, a higher associated rate of medical comorbidites, patient deconditioning due to immobility, and a rigid and nonflexible deformity [3, 4].