Steven S Rothenberg1, Kristin Shipman, Suzanne Yoder. 1. Department of Pediatric Surgery, The Rocky Mountain Hospital for Children, 1601 East 19th Avenue, Suite 5500 Denver, CO 80218, USA. steverberg@aol.com
Abstract
PURPOSE: The aim of this study was to determine the safety and efficacy of limited-access laparoscopic procedures in children by using a modified single-port access (SPA) technique. METHODS: A number of different basic laparoscopic procedures were attempted by using a modified 8-mm operating laparoscope with a 4-mm, 6-degree lens and an incorporated 5-mm operating channel. The operating scope was placed though an umbilical incision. The majority of cases also involved the use of a 3-mm instrument placed through a separate stab-wound incision or 3-mm port. Patient age ranged from 9 months to 16 years and weight from 7 to 60 kg. Procedures included laparoscopic cholecystectomy in 10, appendectomy in 8, enterolysis in 2, ovarian cystectomy in 1, and inguinal hernia repair in 15 patients. RESULTS: All procedures, except one, were successfully completed by using the SPA technique. A hernia repair in a 15-year-old male was converted to a three-port laparoscopic repair, because the operating scope could not adequately access the area. Operative times were longer than comparable procedures if using a standard laparoscopic approach, but a statistical analysis was not performed. There were no operative or postoperative complications. CONCLUSIONS: A modified SPA technique appears to be a safe, viable alternative to a standard laparoscopic approach for some procedures in children. The primary advantage is cosmetic. Visualization and tissue manipulation are more difficult and time consuming. The addition of a single 3-mm instrument at a separate site allows for easier dissection and triangulation, with almost no visible scarring. This may be more beneficial than creating a single 20-mm incision in the umbilicus with multiple ports, with nearly the same cosmetic result.
PURPOSE: The aim of this study was to determine the safety and efficacy of limited-access laparoscopic procedures in children by using a modified single-port access (SPA) technique. METHODS: A number of different basic laparoscopic procedures were attempted by using a modified 8-mm operating laparoscope with a 4-mm, 6-degree lens and an incorporated 5-mm operating channel. The operating scope was placed though an umbilical incision. The majority of cases also involved the use of a 3-mm instrument placed through a separate stab-wound incision or 3-mm port. Patient age ranged from 9 months to 16 years and weight from 7 to 60 kg. Procedures included laparoscopic cholecystectomy in 10, appendectomy in 8, enterolysis in 2, ovarian cystectomy in 1, and inguinal hernia repair in 15 patients. RESULTS: All procedures, except one, were successfully completed by using the SPA technique. A hernia repair in a 15-year-old male was converted to a three-port laparoscopic repair, because the operating scope could not adequately access the area. Operative times were longer than comparable procedures if using a standard laparoscopic approach, but a statistical analysis was not performed. There were no operative or postoperative complications. CONCLUSIONS: A modified SPA technique appears to be a safe, viable alternative to a standard laparoscopic approach for some procedures in children. The primary advantage is cosmetic. Visualization and tissue manipulation are more difficult and time consuming. The addition of a single 3-mm instrument at a separate site allows for easier dissection and triangulation, with almost no visible scarring. This may be more beneficial than creating a single 20-mm incision in the umbilicus with multiple ports, with nearly the same cosmetic result.
Authors: Kamran Ahmed; Tim T Wang; Vanash M Patel; Kamal Nagpal; James Clark; Mariam Ali; Samer Deeba; Hutan Ashrafian; Ara Darzi; Thanos Athanasiou; Paraskevas Paraskeva Journal: Surg Endosc Date: 2010-07-10 Impact factor: 4.584