One-trocar appendectomy in pediatric surgery

Esposito, Ciro

doi:10.1007/s004649900624

Cited by 292 publications

(169 citation statements)

References 8 publications

(7 reference statements)

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“…12,13 This technique uses a single skin and fascial incision for placement of ports. Advances in surgical techniques and instruments, such as multichannel singleaccess ports, novel articulating instruments and thin flexible laparoscopic cameras, have allowed the integration of LESS in urologic surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparo-endoscopic Single Site Surgery in Pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

Khambati

Wehbi

Farhat

2015

CUAJ

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Introduction: Laparo-endoscopic single-site surgery (LESS) is becoming an alternative to standard laparoscopic surgery. Proposed advantages include enhanced cosmesis and faster recovery. We assessed the early post-operative surgical outcomes of LESS surgery utilizing different instruments in the pediatric urological population in Canada. Methods: We prospectively captured data on all patients undergoing LESS at our institution between February 2011 and August 2012. This included patient age, operative time, length of stay, complications and short-term surgical outcomes. Different instruments/devices were used to perform the procedures. Access was achieved through a transumbilical incision. Results: A total of 16 LESS procedures were performed, including seven pyeloplasties, four unilateral and one bilateral varicocelectomies, two simple nephrectomies, one renal cyst decortication and one pyelolithotomy. There was no statistical difference in the operative times, hospital length of stay and cost (pyeloplasty only) in patients undergoing pyeloplasty and varicocelectomy using the LESS technique when compared to an age matched cohort of patients managed with the traditional laparoscopic approach. One pyeloplasty in the LESS group required conversion to open due to a small intra-renal pelvis. There were no immediate or short term post-operative complications; however, one patient experienced a decrease in renal function status post LESS pyeloplasty. Since all procedures were performed by a vastly experienced surgeon at a tertiary center, the generalizability of the results cannot be assessed. Conclusions: There are only a few series that have assessed the role of LESS in pediatric urological surgery. Although our experience is limited by a heterogeneous group of patients with a short follow-up period, the present cohort demonstrates the safety and feasibility of LESS. Further evaluation with randomized studies is required to better assess the role of LESS in pediatric urology.

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Section: Discussionmentioning

confidence: 99%

Laparo-endoscopic Single Site Surgery in Pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

Khambati

Wehbi

Farhat

2015

CUAJ

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“…We have experienced positive results from performing laparoscopic splenectomy and cholecystectomy at one time for treating hereditary spherocytosis that was combined with cholelithiasis. The operation procedure can be difficult to achieve because all instruments come from one direction 20 . Our operation was a rare SILS procedure, when spleen is removed concomitant with the gallbladder (Table 1).…”

Section: Discussionmentioning

confidence: 99%

First experience with single incision laparoscopic surgery in Slovakia: Concomitant cholecystectomy and splenectomy in an 11-year-old girl with hereditary spherocytosis

Cingel¹,

Zabojnikova²,

Kurucova³

et al. 2014

BIOMED PAP

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Aims.Hereditary spherocytosis is an autosomal dominant inheritance disorder of the red blood cell membrane characterized by the presence of spherical-shaped erythrocytes (spherocytes) in the peripheral blood. The main clinical features include haemolytic anemia, variable jaundice, splenomegaly and cholelithiasis caused by hyperbilirubinemia from erythrocyte hemolysis. Splenectomy does not solve the congenital genetic defect but it stops pathological hemolysis in the enlarged spleen. If gallstones are present, it is appropriate to perform cholecystectomy at the time of splenectomy, although the patient has symptoms of gall bladder disease. We present the case of single incision laparoscopic surgical (SILS) concomitant splenectomy and cholecystectomy performed with conventional laparoscopic instruments in an 11-year-old girl with the diagnosis of hereditary spherocytosis. Methods. A 2 -3 cm umbilical incision was used for the placement of two 5 mm trocars and one 10 mm flexible videoscope. Conventional laparoscopic dissector, grasper, Ligasure, Harmonic Ace and hemoclips were the main tools during surgical procedure. We prefer Single Incision Laparoscopic Surgery Foam Port (Covidien) as the single umbilical device for introduction into the abdominal cavity. First, we performed cholecystectomy, then the gallbladder was put aside over the liver and after that we peformed splenectomy. To remove the detached spleen and gallbladder, a nylon extraction bag is introduced through one of the port sites. The spleen is than morcellated in the bag with forceps and removed in fragments. After that we removed them and the umbilical fascial incision was closed. Result. Splenectomy is the only effective therapy for this disorder and often it is performed in combination with cholecystectomy. Conventional surgery requires a wide upper abdominal incision for correct exposure of the gallbladder and spleen. Our experience shows that SILS splenectomy and cholecystectomy is feasible even in young children and despite the small number of cases in the world, we consider the combined laparoscopic approach safe and effective for the treatment of hereditary spherocytosis. Conclusion. According to actually published guidelines, the laparoscopic approach to concomitant splenectomy and cholecystectomy is recommended, but it depends on the availability of appropriately trained surgeons and suitable equipment.

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“…In 1998, a single-incision laparoscopic appendectomy [9] was described, in which the appendix was laparoscopically mobilized and the appendectomy was extracorporeally performed through a single umbilical incision. Soon, other basic and advanced procedures were reported, such as hysterectomy, nephrectomy, pyeloplasty, cholecystectomy, and right hemicolectomy [10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Transumbilical single-incision laparoscopic hysterectomy for large uterus: feasibility of the technique

2009

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Total hysterectomy has been shown to have more clinical benefits when performed with a laparoscopic approach in comparison to traditional open surgery. However, multiple puncture sites might increase trocarassociated complications, such as bleeding, hernias, and wound infection and the cosmetic results are not always optimal. The umbilicus, an embryonic natural orifice, is an anatomical structure that may be used to perform advanced gynecological procedures, further reducing the morbidity associated with classical laparoscopic surgery. Leiomyomas are one of the most common indications for hysterectomy in women not wishing to conceive. Uterine size may be a limiting factor for laparoscopic single-incision approach to hysterectomy due to difficulties encountered to achieve a proper operative field. Several practical maneuvers can be used to assure a safe dissection while managing voluminous uteri. Herein we present our preliminary experience of transumbilical single-incision laparoscopic hysterectomy with a multichannel port in a patient affected of myomatous uterus.

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One-trocar appendectomy in pediatric surgery

Cited by 292 publications

References 8 publications

Laparo-endoscopic Single Site Surgery in Pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

Laparo-endoscopic Single Site Surgery in Pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

First experience with single incision laparoscopic surgery in Slovakia: Concomitant cholecystectomy and splenectomy in an 11-year-old girl with hereditary spherocytosis

Transumbilical single-incision laparoscopic hysterectomy for large uterus: feasibility of the technique

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