Table 4.

Hand instruments used for LESS.

PRODUCT	DESCRIPTION
Autonomy laparo-angle articulating instruments (Cambridge Endoscopic Devices, Inc., Framingham, MA, USA)	Seven degrees of freedom, allowing unprecedented access to the most difficult to reach areas. Full articulation that maps the surgeon’s hand motions. A tip that can rotate 360° around its axis for precise positioning. The capability of performing simultaneous actions such as articulating downward while rotating. Handle locks at any angle and rotates.
Roticulator endo-instruments (Covidien, Mansfield, MA, USA)	Single use instruments with a grooved collar that articulates the jaws and the last 2 cm of the shaft from 0 to 80 degrees. The scalloped dial located on the handle rotates the shaft and jaws 360 degrees.
SILS hand instruments (Covidien, Mansfield, MA, USA)	All four new instruments have been designed to enhance the surgeon’s flexibility and visualization when performing SILS™ procedures. While the new line has the potential to revolutionize surgical instrumentation, the design is intuitive enough to allow surgeons and nurses to quickly master the operation of the instruments.
Diamond-flex articulating dissectors (Cardinal Health, Dublin, OH, USA)	These instruments can articulate once placed in the peritoneal space for access around anatomical structures.
DAPRI curved instruments (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany)	The first-generation curved coaxial instruments to increase the operative space between the surgeon’s hands. Special curved instruments permit adequate triangulation, a good overview of the site and exact manipulation both inside and outside of the body.
Pre-bent HiQ LS hand Instruments (Olympus Corp, Tokyo, Japan)	These reusable instruments have a double-curved shaft to allow for independent jaw rotation and excellent maneuverability.