With proper patient selection and laparoscopic experience, single port colorectal surgery can be performed for even the most complex colorectal procedures. Further studies are needed to assess the benefits that single port colorectal surgery has over a conventional laparoscopic approach.

O ne can hardly pick up a publication in the defense arena these days without seeing an article on close air support. The need to replace the aging A-1O ground attack fighter-the "Warthog"-has fanned the flames of a controversy that has smoldered since World War II. In compliance with The Goldwater-Nichols DOD Reorganization Act of 1986 and in response to a congressional call to study close air support (including the feasibilty of transferring the mission to the Army), then-JCS Chairman Admiral William Crowe submitted a roles and functions report including the following statement: CAS is not an issue only for the Army and the Air Force .... All four services perform the CAS function. CAS for naval operations is assigned to both the Navy and the Marine Corps. CAS for land operations was assigned to the Air Force when it became an independent service, and the Army was permitted to maintain organic aviation with relatively unspecified tasks. All four services have CAS-capable aircraft employed under joint doctrine. In this manner we have insured that CAS is available to lower-level ground commanders on a regular basis, while still providing the theater commanders the capability to focus significant combat power in a specified area. The issue cannot be whether to transfer CAS from the Air Force to the Army; it is already present in both services, as well as in the Navy and Marine Corps.' Under the new spirit of jointness ushered in by Goldwater-Nichols, the word from the Chairman sounded sensible. But wait-the Army and Air Force chiefs submitted a joint dissenting opinion: The Army and the Air Force do not regard attack helicopters as CAS weapons systems. Attack helicopter units lack the speed, lethality, and flexibility to enable the theater commander to mass, concentrate, or shift air support intratheater, which is a vital characteristic of CAS. We both firmly believe that the original concept of Air Force fixed-wing aircraft providing support in close proximity to friendly forces remains valid and properly defines CAS today.' Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

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This article reports results of a survey of police officials, prosecuting attorneys, and members of homosexual groups in the seven states that had decriminalized private homosexual behavior between consenting adults. Despite the dire predictions of many, the responses indicate that, among other things, decriminalization has had no effect on the involvement of homosexuals with minors, the use of force by homosexuals, or the amount of private homosexual behavior. Additionally, decriminalization reportedly eased somewhat the problems of the homosexual community and allowed the police to devote more time to the investigation of what generally are regarded as more serious criminal offenses.

The authors are thankful for the opportunity to address the comments made by Dr. Fazio and by Dr. Bergamaschi regarding our manuscript entitled ''Single Incision Laparoscopic Colorectal Surgery: A Single Surgeon Experience of 102 Consecutive Cases.''The authors greatly appreciate both the insightful comments offered by Dr. Vic Fazio as well as his understanding that single-incision laparoscopic colorectal surgery is in its infancy. We also agree that benefits and outcomes will prove to be at least equivalent and likely superior to traditional laparoscopy, as its superiority to hand-assist surgery has been shown by others [1]. We are now indeed in the process of defining patient selection, disease processes, and limitations of a single-port technique. Further work is in process and results are forthcoming.As far as Dr. Bergamaschi's comments, we agree that institutional review board (IRB) approval should be mandatory for such studies and greatly appreciate Dr. Bergamaschi's acknowledgement that this was indeed the case in our study as we consider it routine. We also agree that there is a need for innovation in surgery and that this must be implemented in accordance with the rules of evidence. However, we cannot agree with his statement that laparoendoscopic single-site surgery (LESS) is neither technically simple nor random. Given the tremendous advances in new technology (Olympus endo-eye flexible tip 5-mm camera and 5-mm energy devices to name a couple), we are now able to perform even complex abdominal operations in an even less invasive fashion. In fact, the ergonomic challenges and time constraints of traditional laparoscopy are often greatly improved with a single-port technique. LESS is nothing more than grouping the ports together and operating through a single incision. Having performed well over 1,000 laparoscopic colorectal procedures primarily through a three-port technique popularized in the United States by John Marks, MD, the transition to single-incision surgery is quite simple. This has become our routine access as it is essentially a three-trocar technique with the grouping of the ports at a single-site. The authors also agree with Dr. Bergamaschi that the goal for innovative advances in surgery should be the improvement of patient benefit as that was the sole purpose of this study while better defining the patient selection, disease processes, and optimal technique. With regard to the actual technique, single-incision laparoscopy is in its infancy while standardized techniques have not yet been defined. However, it remains a three-trocar laparoscopic procedure. As we are now quickly approaching our second 100 cases, much has been learned. With the ports arranged in a triangular configuration directed to the pathology, the camera is best placed through the apical port with a grasper in the surgeon's right hand and the energy device in the left. The same surgical principles that pertain to open surgery and utilized for a traditional laparoscopic approach are strongly adhered to with this access t...