Single-incision laparoscopic surgery in children: initial single-center experience

Garey, Carissa L.; Laituri, Carrie A.; Ostlie, Daniel J.; Snyder, Charles L.; Andrews, Walter S.; Holcomb, George; Peter, Shawn D. St.

doi:10.1016/j.jpedsurg.2011.02.020

Cited by 58 publications

(27 citation statements)

References 20 publications

(18 reference statements)

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“…Mobilization of umbilical stem creates a place for eventual fluid collection and infection 26 . This has been reported in several cases of pediatric SILS appendectomy for complicated appendicitis but not in cholecystectomy or splenectomy 27,28 . Guidelines on hereditary spherocytosis published in 2011 reflect current opinion on the surgical management in children with hereditary spherocytosis.…”

Section: Discussionmentioning

confidence: 87%

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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Section: Discussionmentioning

confidence: 87%

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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“…[18][19][20][21][22][23] Many diseases are not accompanied by a specific lesion site, such as Meckel diverticulum and Crohn disease, making preoperative identification of any lesion important. To our knowledge, this is the first case report showing the diagnosis, localization, and tattooing of an OGIB lesion of the small intestine by preoperative DBE, and removal of the lesion by subsequent T-SILS.…”

Section: Discussionmentioning

confidence: 99%

Success of Minimally Invasive Transumbilical Single-Incision Laparoscopic Surgery (T-SILS) Plus Double-Balloon Endoscopy (DBE) for Pediatric Intestinal Angiodysplasia: A Case Report

Mori

Koike

Inoue

et al. 2015

International Surgery

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We describe here a child with angiodysplasia of the small intestine, diagnosed by doubleballoon endoscopy (DBE), who was treated with transumbilical single-incision laparoscopic surgery (T-SILS). A 9-year-old boy presented to another hospital with intermittent fresh melena of a duration of 5 months and 4 days. Anoscopy and gastric mucosal membrane scintigraphy were unsuccessful diagnostically, and he was referred to our hospital for further examination and treatment. Under general anesthesia, we performed DBE by an anal route, with the ileum assessed for a distance of about 150 cm from the ileocecal valve. Although no bleeding lesion was found in the colon, a flat elevated venous lake approximately 20 mm in size was observed 20 cm from the ileocecal valve, suggesting angiodysplasia of the small intestine. A tattoo was made under DBE, and wedge resection by T-SILS was performed 1 month later under general anesthesia. The excised specimen appeared as a flat, elevated venous lake approximately 20 mm in size. Histopathologic analysis revealed several dilated and distorted veins within the submucosa of the small intestine. The patient was diagnosed with angiodysplasia of the small intestine. His postoperative course was uneventful, and he remained free of recurrent gastrointestinal bleeding 18 months after the operation. This is the first case report showing the diagnosis, localization, and tattooing of an obscure gastrointestinal bleeding lesion of the small intestine by preoperative DBE and removal of the lesion by subsequent T-SILS in children.

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“…However, because the incision is made, infraumbilical curvilinear or intraumbilical ports would be extremely close to each other, and triangulation of the ports would be very limited. Furthermore, if defects occur on the fascia due to the ports merging together, either the pneumoperitoneum cannot be achieved sufficiently or gas flow would need to stay at the maximum level (1). Because the diameter of the umbilicus is shorter in children than adults, this long incision may extend outside the umbilicus and may lead to visible scar formation.…”

Section: Discussionmentioning

confidence: 99%

“…Recently there have been reports of many techniques such as single incision laparoscopic surgery, single site surgery, etc. (1)(2)(3). We know that in all of these reported techniques, a 20-30 mm incision is needed below or on the umbilicus with or without using a multiport access device.…”

Section: Introductionmentioning

confidence: 99%

Periumbilical Multiport Laparoscopic Appendectomy: A Preliminary Experience Using a Novel Technique

Akkoyun¹,

Sükan²

2013

Ann Colorectal Res

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Background: Single incision laparoscopic surgery (SILS) is especially developed to achieve better cosmetic results. Using the umbilicus for ports access is widely accepted in this approach. Objectives: The aim of this study was to evaluate our initial experience with a new port access technique applied for laparoscopic appendectomy: Periumbilical Multiport Laparoscopic Appendectomy (PUMLA). Patients and Methods: Between January 2011 and March 2013, a total of 14 appendectomies were performed using a new port access technique. Patients were selected randomly. Thirteen of these cases had acute appendicitis, and one patient had familial Mediterranean fever (FMF). During these operations, three separate curvilinear incisions were created in the periumbilical skin folds and ports were placed in these ways. The five millimeter port was used for a zero degree telescope. The other two were used to manipulate the laparoscopic instruments. The appendectomy was performed intracorporeally in six cases; however, in eight cases, the appendix was taken out via a trocar after dissecting the mesoappendix, then the appendectomy was performed extracorporeally. Reconstruction was not needed to the umbilicus as there was no anatomical distortion. Results: Five patients were female, and nine were male. Age range was 5 to 15 years (mean 9.7 years). Operation time was between 20 and 82 minutes (mean 43 minutes). We did not need to convert to standard laparoscopic appendectomy or place an additional port in any of these patients. The average postoperative hospitalization was 14.1 hours (5-33 h). No complications such as wound infection, trocar site hernia, adhesive small-bowel obstruction, or abscess were observed in the early and late postoperative period. Good cosmetic results were obtained after the separate periumbilical curvilinear incision technique. Conclusions: We found that this new port access technique is feasible, safe, and associated with good cosmetic results.

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Single-incision laparoscopic surgery in children: initial single-center experience

Cited by 58 publications

References 20 publications

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

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

Success of Minimally Invasive Transumbilical Single-Incision Laparoscopic Surgery (T-SILS) Plus Double-Balloon Endoscopy (DBE) for Pediatric Intestinal Angiodysplasia: A Case Report

Periumbilical Multiport Laparoscopic Appendectomy: A Preliminary Experience Using a Novel Technique

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