Journal List > J Korean Assoc Pediatr Surg > v.19(2) > 1015934

Song and Jung: Early Experiences of Single Incision Laparoscopic Surgery in Pediatrics in a Single Center

Abstract

Laparoscopic surgery has become popular in the past few decades, owing to less postoperative pain, fast recovery, and better cosmetic outcomes. The laparoscopic approach has been employed in pediatric surgery for the same reasons. After the first attempts of single incision laparoscopic appendectomy in pediatrics in 1998, single incision laparoscopic surgery (SILS) has recently been proven to be safe and feasible for the pediatric population. However, limitations have been reported for SILS, such as the wide learning curve, compared to standard laparoscopic surgery, and the restricted number of hospitals with surgical training programs including SILS. In this study, we intend to present our initial experiences with SILS in children, and to describe the technique, instruments used, and outcomes. This is a retrospective study of 71 pediatric patients who underwent SILS, at a tertiary medical center, between September, 2012 and August, 2013. Electronic medical records were reviewed for demographics, type of procedure, operation time, use of additional ports, conversion to open surgery, complications and hospital stay. Additional ports were inserted in 4 cases, for the purpose of traction. Postoperative complications were noted in 13 cases, which were mostly related to wound inflammation or formation of granulation tissue. According to our analyses, patients with complications had significantly longer use and more frequent use of pain killers. Notwithstanding the small sample size, many of the procedures performed in pediatric patients seem to be possible with SILS.

Figures and Tables

Table 1
Cases of Single Incision Laparoscopic Surgery
jkaps-19-90-i001
Table 2
Cases Using Assist Ports in addition to Gloveport®
jkaps-19-90-i002

References

1. Mesas Burgos C, Ghaffarpour N, Almstrom M. Single-site incision laparoscopic cholecystectomy in children: a single-center initial experience. J Pediatr Surg. 2011; 46:2421–2225.
2. Pelosi MA, Pelosi MA 3rd. Laparoscopic supracervical hysterectomy using a single-umbilical puncture (mini-laparoscopy). J Reprod Med. 1992; 37:777–784.
3. Esposito C. One-trocar appendectomy in pediatric surgery. Surg Endosc. 1998; 12:177–178.
4. Harmon CM. Single-site umbilical laparoscopic pyloromyotomy. Semin Pediatr Surg. 2011; 20:208–211.
5. Holcomb GW 3rd. Single-site umbilical laparoscopic cholecystectomy. Semin Pediatr Surg. 2011; 20:201–207.
6. Dutta S. Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations. J Pediatr Surg. 2009; 44:1741–1145.
7. Bruzoni M, Dutta S. Single-site umbilical laparoscopic splenectomy. Semin Pediatr Surg. 2011; 20:212–218.
8. Yannam GR, Griffin R, Anderson SA, Beierle EA, Chen MK, Harmon CM. Single incision pediatric endosurgery (SIPES) appendectomy - is obesity a contraindication? J Pediatr Surg. 2013; 48:1399–1404.
9. Oltmann SC, Garcia NM, Ventura B, Mitchell I, Fischer AC. Single-incision laparoscopic surgery: feasibility for pediatric appendectomies. J Pediatr Surg. 2010; 45:1208–1112.
10. Islam S, Adams SD, Mahomed AA. SILS: Is it cost- and time-effective compared to standard pediatric laparoscopic surgery? Minim Invasive Surg. 2012; 2012:807609.
11. Burjonrappa SC, Nerkar H. Teaching single-incision laparoscopic appendectomy in pediatric patients. JSLS. 2012; 16:619–622.
12. Saldaña LJ, Targarona EM. Single-incision pediatric endosurgery: a systematic review. J Laparoendosc Adv Surg Tech A. 2013; 23:467–480.
13. Tay CW, Shen L, Hartman M, Iyer SG, Madhavan K, Chang SK. SILC for SILC: Single institution learning curve for single-incision laparoscopic cholecystectomy. Minim Invasive Surg. 2013; 2013:381628.
14. Hass EM, Nieto J, Raqupathi M, Aminian A, Patel CB. Critical appraisal of learning curve for single incision laparoscopic right colectomy. Surg Endosc. 2013; Jul. 23. Epub ahead of print.
15. Hopping JR, Bardakcioqlu O. Single-port laparoscopic right hemicolectomy: the learning curve. JSLS. 2013; 17(2):194–197.
16. Lacher M, Muensterer OJ, Yannam GR, Aprahamian CJ, Perger L, Megison M, Yu DC, Beierle EA, Anderson SA, Chen MK, Harmon CM. Feasibility of single-incision pediatric endosurgery for treatment of appendicitis in 415 children. J Laparoendosc Adv Surg Tech A. 2012; 22:604–608.
17. Szavay PO, Luithle T, Nagel C, Fuchs J. Weight-adapted surgical approach for laparoendoscopic single-site surgery in pediatric patients using low-cost reusable instrumentation: a prospective analysis. J Laparoendosc Adv Surg Tech A. 2013; 23:281–286.
18. Nwokoma NJ, Tsang T. chap 2. Laparoscopy in children and infants. In : Shamsa A, editor. Advanced Laparoscopy. 2011. InTech;p. 27–46.
19. Ahmed A. Laparoscopic surgery in children-anaesthetic considerations. J Pak Med Assoc. 2006; 56:75–79.
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