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- Title
Single-incision pediatric endosurgery: lessons learned from our first 224 laparoendoscopic single-site procedures in children.
- Authors
Hansen, Erik; Muensterer, Oliver; Georgeson, Keith; Harmon, Carroll; Hansen, Erik N; Muensterer, Oliver J; Georgeson, Keith E; Harmon, Carroll M
- Abstract
<bold>Purpose: </bold>To identify technical difficulties during single-incision pediatric endoscopic surgery (SIPES) cases and to highlight solutions.<bold>Materials and Methods: </bold>After IRB approval, all SIPES cases were prospectively collected, and the surgeons involved were polled for technical difficulties encountered and their operative solutions.<bold>Results: </bold>Over a period of 13 months, 224 pediatric SIPES cases were performed in 223 pediatric patients (92 female, 131 male) aged 3 weeks to 19 years. Among these were 130 appendectomies, 32 pyloromyotomies, 32 cholecystectomies, 11 inguinal hernia repairs, 6 Nissen fundoplications and 4 laparoscopic-assisted endorectal pullthrough procedures. Eighteen procedures (8%) employed a primary extra-umbilical instrument in addition to the transumbilical trocar(s). Thirty procedures (13%) begun via a single-site technique required additional trocars for completion. None required laparotomy. Intraoperative complications are discussed. The main challenges of SIPES are: (1) variable umbilical anatomy, (2) large size of current proprietary multitrocar devices, (3) trocar crowding, (4) intra-abdominal exposure, (5) fewer degrees of freedom, (6) clashing instruments, (7) in-line endoscope viewing, and (8) limited number of working ports. We discuss coping strategies to address these issues.<bold>Conclusion: </bold>Many of the drawbacks of SIPES can be overcome by specific techniques, which can make SIPES procedures more broadly feasible and applicable within pediatric endosurgery.
- Subjects
PEDIATRIC surgery; ENDOSCOPIC surgery; APPENDECTOMY; OPERATIVE surgery; SURGICAL complications; ABDOMINAL surgery; FUNDOPLICATION; COMPARATIVE studies; DIGESTIVE system diseases; ENDOSCOPES; LAPAROSCOPY; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; MEDICAL protocols; RESEARCH; PILOT projects; PRODUCT design; EVALUATION research; TREATMENT effectiveness
- Publication
Pediatric Surgery International, 2011, Vol 27, Issue 6, p643
- ISSN
0179-0358
- Publication type
journal article
- DOI
10.1007/s00383-010-2735-x