1
|
Ramot Y, Rousselle S, Steiner M, Lavie Y, Ezov N, Nyska A. Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs. Toxicol Pathol 2021; 50:211-217. [DOI: 10.1177/01926233211067960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.
Collapse
Affiliation(s)
- Yuval Ramot
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel
| | | | | | | | - Nati Ezov
- Envigo CRS (Israel), Ness Ziona, Israel
| | - Abraham Nyska
- Toxicologic Pathology, Tel Aviv and Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
2
|
Zhao Y, Chen Q, Hu JN, Shen Q, Xia L, Yan LZ, Wang Y, Zhu XJ, Li WJ, Hu Y, Zhang Q. Application of multidirectional stitching technology in a laparoscopic suturing instructional program: a randomized controlled trial. BMC MEDICAL EDUCATION 2020; 20:248. [PMID: 32753043 PMCID: PMC7409432 DOI: 10.1186/s12909-020-02146-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Surgeon suturing technology plays a pivotal role in patient recovery after laparoscopic surgery. Intracorporal suturing and knot tying in minimally invasive surgery are particularly challenging and represent a key skill for advanced procedures. In this study, we compared the application of multidirectional stitching technology with application of the traditional method in a laparoscopic suturing instructional program. METHODS We selected forty residents within two years of graduation to assess the specialized teaching of laparoscopic suturing with laparoscopic simulators. The forty students were randomly divided into two groups, a control group and an experimental group, with twenty students in each group. The control group was scheduled to learn the traditional suture method, and the experimental group applied multidirectional stitching technology. The grades for suturing time, thread length, accuracy of needle entry, stability of the knot, tissue integrity, and tightness of the tissue before and after the training program were calculated. RESULTS There was no significant difference between the two groups before the learning intervention. After the program, both groups significantly improved in each subject. There were significant differences between the control group and the experimental group in suture time (P = 0.001), accuracy of needle entry and exit (P = 0.035), and whether the suture tissue had cracks (P = 0.030). However, the two groups showed non-significant differences in thread length (P = 0.093), stablity of the knot (P = 0.241), or tightness of the tissue (P = 0.367). CONCLUSIONS Multidirectional stitching technology improves the efficiency and effectiveness of traditional laparoscopic suture instructional programs. It might be a practicable, novel training method for acquiring proficiency in manual laparoscopic skills in a training setting.
Collapse
Affiliation(s)
- Yu Zhao
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Qiong Chen
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Jia-Ning Hu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Qi Shen
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Lu Xia
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Lin-Zhi Yan
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yi Wang
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Xiu-Jie Zhu
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Wen-Ju Li
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yue Hu
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Qiong Zhang
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
| |
Collapse
|
3
|
Mattei P. Single-site robotic-assisted laparoscopic cholecystectomy in children and adolescents: a report of 20 cases. Surg Endosc 2017; 32:2402-2408. [PMID: 29218659 DOI: 10.1007/s00464-017-5939-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/17/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Single-site laparoscopy is increasingly popular for straightforward operations like appendectomy. Due to limited triangulation and maneuverability, single-site cholecystectomy is riskier and more difficult. Robotics offer to make it easier and safer. METHODS Twenty children and adolescents underwent robotic-assisted single-site cholecystectomy at a large academic children's hospital. Patients were not randomized; patients were offered the option of robotic-assisted single-site (SSR) or standard four-incision laparoscopic (LAP) cholecystectomy. Demographics and perioperative details were compared with those of a comparable cohort who underwent LAP during the same period. RESULTS The two groups were similar in physical characteristics and indications for operation. The robotic operations took longer but both groups received similar PRN doses of parenteral opiates. Patients in the SSR group were all discharged on the first postoperative day. There were no major complications in either group but a slightly higher incidence of minor wound complications in the SSR group. CONCLUSION Robotic-assisted single-site cholecystectomy appears to be a safe alternative to standard laparoscopy with a similar postoperative pain profile, short postoperative lengths of stay, and, for some, a superior cosmetic result. Nevertheless, it comes with longer set-up and operative times, a higher incidence of minor wound complications, an unknown but possibly higher risk of incisional hernia, and higher costs.
Collapse
Affiliation(s)
- Peter Mattei
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 34th Street & Civic Center Blvd., Philadelphia, PA, 19104-4399, USA.
| |
Collapse
|
4
|
Sattarova V, Eaton S, Hall NJ, Lapidus-Krol E, Zani A, Pierro A. Laparoscopy in pediatric surgery: Implementation in Canada and supporting evidence. J Pediatr Surg 2016; 51:822-7. [PMID: 26944184 DOI: 10.1016/j.jpedsurg.2016.02.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/07/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to assess the diffusion of laparoscopy usage in Canadian pediatric centers and the relationship between uptake of laparoscopic surgery and the level of evidence supporting its use. METHODS National data on four pediatric laparoscopic operations (appendectomy, pyloromyotomy, cholecystectomy, splenectomy) were analyzed using the Canadian Institute for Health Information Discharge Database (2002-2013). The highest level of evidence to support the use of each procedure was identified from Cochrane, Embase, and Pubmed databases. Chi-square test for trend was used to determine significance and time to plateau. RESULTS There were 28,843 operations (open: 12,048; laparoscopic: 16,795). Use of laparoscopic procedures increased over time (p<0.0001). A plateau was reached for cholecystectomy (2006), splenectomy (2007), and appendectomy (2012), but not for pyloromyotomy. Laparoscopic pyloromyotomy in 2013 remains less diffused than the other procedures (p<0.0001). Laparoscopic appendectomy and pyloromyotomy are supported by level-1a evidence in children, whereas cholecystectomy and splenectomy are supported by level-1a evidence in adults but level-3 in children. CONCLUSIONS In Canada, it has taken a long time to reach high-level implementation of laparoscopic surgery in children. Laparoscopic cholecystectomy first reached plateau, whereas laparoscopic pyloromyotomy continues to increase but remains low despite high level of evidence in support of its usage compared to open surgery.
Collapse
Affiliation(s)
- Victoria Sattarova
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Simon Eaton
- UCL Institute of Child Health, London, United Kingdom
| | - Nigel J Hall
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Eveline Lapidus-Krol
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
5
|
Herbert GL, Cundy TP, Singh P, Retrosi G, Sodergren MH, Azzie G, Darzi A. Validation of a pediatric single-port laparoscopic surgery simulator. J Pediatr Surg 2015; 50:1762-6. [PMID: 25933925 DOI: 10.1016/j.jpedsurg.2015.03.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/05/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aims to adapt an existing multiport pediatric laparoscopic surgery simulator to be suitable for pediatric single-port laparoscopy and to investigate construct validity for its use as a resource for skills training and assessment. METHODS An existing pediatric-sized box trainer was modified to accommodate a commercially available port. A total of 41 participants (18 novices, 16 intermediates and 7 experts) were recruited to complete four curriculum tasks via a single-port access approach. Objective task performance scores were evaluated. RESULTS Task completion times and performance scores were significantly different between novices and experts for the peg transfer (P = 0.02, P = 0.008 respectively), pattern cut (P < 0.001, P < 0.001 respectively) and ligating loop (P = 0.038, P = 0.035 respectively). There were significant differences in outcomes between novices and intermediates for all tasks, including the intracorporeal suture task (P ≤ 0.001). There were no significant differences in outcomes between intermediates and experts for all tasks. CONCLUSIONS The Pediatric Laparoscopic Surgery (PLS) simulator can be easily adapted for single-port laparoscopic surgery to be construct valid for the peg transfer, ligating loop and pattern cut tasks. There is scope for additional tasks to be developed that focus on the unique technical challenges and skills associated with single-port techniques.
Collapse
Affiliation(s)
- Geraint L Herbert
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, UK
| | - Thomas P Cundy
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, UK.
| | - Pritam Singh
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, UK
| | - Giuseppe Retrosi
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, London, UK
| | - Mikael H Sodergren
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, UK
| | - Georges Azzie
- Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Ara Darzi
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, UK
| |
Collapse
|
6
|
Concha JAM, Cartes-Velásquez R, Delgado CM. Single-incision laparoscopic appendectomy versus conventional laparoscopy in adults. A systematic review. Acta Cir Bras 2015; 29:826-31. [PMID: 25517497 DOI: 10.1590/s0102-86502014001900010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/21/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine the best treatment option for not complicated acute appendicitis (AA) in adult patients, between single incision laparoscopy (SIL) and conventional laparoscopy (CL), measured by morbidity associated with disease. METHODS Systematic review. Articles of adults diagnosed with AA treated by SIL or CL were analyzed. Databases included: MEDLINE, LILACS, IBECS, Web of Science, Scopus and Cochrane, using MeSH terms and free words. The studies were analyzed using the MINCIR methodology. Variables included: conversion rate, morbidity, hospital stay, surgery duration, and methodological quality (MQ) of primary studies. Averages, medians and weighted averages were calculated. RESULTS Thirteen articles were analyzed. For SIL and CL the conversion rate were 3.4% and 0.7 %, the morbidity were 8% and 6.5%, the hospital stay were 2.5 and 2.8 days, the surgery duration were 53.4 and 53.8 minutes, and the MQ were 14.3±6.6 and 16.0±6.9 points, respectively. CONCLUSION With the exception of the conversion rate, there are no differences between single incision laparoscopy and conventional laparoscopy for the treatment of acute appendicitis in adults.
Collapse
|
7
|
Sharp NE, Thomas P, St Peter SD. Single-incision laparoscopic ileocecectomy in children with Crohn's disease. J Laparoendosc Adv Surg Tech A 2014; 24:589-92. [PMID: 24918784 DOI: 10.1089/lap.2013.0517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION We previously reported our experience with standard laparoscopic ileocecectomy, but we have recently used a single-incision laparoscopic approach. PATIENTS AND METHODS We conducted a retrospective review of a single surgeon's experience from 2009 to 2013. RESULTS Twenty-eight children 11-18 years of age (mean, 15.5 years) with a mean body mass index of 18.9±3 kg/m(2) underwent single-incision laparoscopic ileocecectomy for Crohn's disease. Mean operative time was 86.5±25.9 minutes (range, 56-166 minutes). There were no extra ports placed or conversions to open surgery. Five children (18%) were on parenteral nutrition at time of surgery, 14 (50%) were on steroids, and 9 (32%) were on tumor necrotic factor inhibitors. A stapled extracorporeal anastomosis was performed in all children. Complications included abscess (n=4), small bowel obstruction (n=3), superficial wound infection (n=3), and small bowel perforation (n=1). Some patients had more than one complication. Of those with complications, 5 (56%) were on steroids, 5 (56%) were on tumor necrotic factor inhibitors, and 1 patient was on both. The perforation occurred at a point of adhesiolysis also involved with Crohn's disease. There were no anastomotic leaks. Median follow-up was 17 months (range, 1-47 months). CONCLUSIONS Single-incision laparoscopic ileocecectomy is safe and feasible in pediatric patients with Crohn's disease.
Collapse
Affiliation(s)
- Nicole E Sharp
- Department of Surgery, The Children's Mercy Hospital , Kansas City, Missouri
| | | | | |
Collapse
|
8
|
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; 23:281-6. [PMID: 23402289 DOI: 10.1089/lap.2012.0466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Laparoendoscopic single-site surgery (LESS) in pediatric patients has emerged as a viable alternative to standard laparoscopy. The aim of our investigation was to assess different surgical approaches for LESS, stratifying by weight. SUBJECTS AND METHODS From March 2010 to April 2012 LESS was performed in 42 children. Children weighing below 10 kg underwent LESS through an umbilical incision using two 3-mm trocars and one 5-mm trocar. Patients above 10 kg were operated on using a metal multiuse single-site single port (X-Cone; Karl Storz Endoskope, Tuttlingen, Germany). Conventional straight laparoscopic instruments were used in all cases. RESULTS Mean age at operation was 100 months (range, 0.25-207 months), and mean weight was 27 kg (range, 3.1-82 kg). Median operating time was 74 minutes (range, 36-300 minutes). Eighteen children underwent LESS using two 3-mm trocars and one 5-mm trocar; 1 case required two 5-mm trocars and one 10-mm trocar. Twenty-three patients were operated on with the multiuse device. All operations were carried out safely in a standard laparoscopic transperitoneal technique with full achievement of the surgical target. In none of the patients was an intraoperative complication noticed. Postoperatively two complications were noted, which resolved spontaneously. CONCLUSIONS LESS for pediatric patients can be done safely and efficiently with even less trauma than in conventional laparoscopy irrespective of age and weight. However, different surgical approaches have to be considered as disposable single-site ports are not available for infants and small children. To decrease operative expenses, conventional multiuse trocars and a multiuse single-site port were used with conventional laparoscopic instruments.
Collapse
Affiliation(s)
- Philipp O Szavay
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany.
| | | | | | | |
Collapse
|
9
|
Lacher M, Kuebler JF, Yannam GR, Aprahamian CJ, Perger L, Beierle EA, Anderson SA, Chen MK, Harmon CM, Muensterer OJ. Single-incision pediatric endosurgery for ovarian pathology. J Laparoendosc Adv Surg Tech A 2013; 23:291-6. [PMID: 23402287 DOI: 10.1089/lap.2012.0380] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite being pioneered by gynecologists, single-incision endosurgery has not been widely reported for the treatment of ovarian and adnexal pathology in neonates, children, and adolescents. We describe our initial experience using single-incision pediatric endosurgery (SIPES) for these indications and discuss advantages and drawbacks. SUBJECTS AND METHODS All children who underwent SIPES with a preoperative diagnosis of ovarian or adnexal pathology were included in the study. Data on age, operative time, complications, length of hospital stay, and outcomes were collected. RESULTS From January 2010 until January 2012, 19 girls (mean age, 11.4 years; range, 6 days-17 years; weight range, 4.0-90 kg) underwent SIPES procedures for ovarian or adnexal diagnoses, including hemorrhagic/follicular/paratubal cysts (n=8), torsion (n=7), tumor (n=3), and parauterine cyst (n=1). The operations included cyst unroofing (n=4), detorsion and oophoropexy (n=7), (salpingo)oophorectomy (n=5), marsupialization of cyst (n=2), and cyst aspiration (n=1). Median operative time was 42 ± 29 minutes; there were no conversions to conventional laparoscopy or open surgery. Fifteen patients (79%) were discharged within 24 hours after the procedure. There were no peri- or postoperative complications. Histopathology showed hemorrhagic/follicular/paratubal cyst (n=7), necrotic/calcified ovarian tissue after torsion (n=6), cystadenofibroma (n=1), granulosa cell tumor (n=1), and mature teratoma (Grade 0) (n=1). CONCLUSIONS SIPES is an excellent alternative to conventional laparoscopy for the treatment of adnexal pathology. Using a single umbilical incision that can be enlarged instead of three smaller trocar sites facilitates the resection and extraction of ovarian masses without compromising cosmesis.
Collapse
Affiliation(s)
- Martin Lacher
- Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Knott EM, Gasior AC, Holcomb GW, Ostlie DJ, St Peter SD. Impact of body habitus on single-site laparoscopic appendectomy for nonperforated appendicitis: subset analysis from a prospective, randomized trial. J Laparoendosc Adv Surg Tech A 2012; 22:404-7. [PMID: 22577809 DOI: 10.1089/lap.2012.0056] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There have been several series documenting the utility of single-site laparoscopic appendectomy. However, there are no data to support patient selection based on their physical characteristics. We recently completed a large prospective, randomized trial comparing single-site laparoscopic appendectomy with standard three-port laparoscopic appendectomy for nonperforated appendicitis. This dataset was used to examine the relative impact of body habitus on operative approach. SUBJECTS AND METHODS We performed an analysis of the dataset collected in a prospective, randomized trial of 360 appendectomy patients who presented with nonperforated appendicitis. Body mass index (BMI) was calculated and plotted on a growth chart to obtain BMI percentile according to gender and age. Standard definitions for overweight (BMI 85-95%) and obesity (BMI >95%) were used. RESULTS In the single-site group there were 26 overweight and 19 obese patients. In the three-port group there were 25 overweight and 16 obese patients. There were no significant differences between overweight and normal with either approach. However, with the single-site approach there was longer mean operative time, more doses of postoperative narcotics given, longer length of stay, and greater hospital charges in obese patients. In the three-port group, there were no differences between normal and obese patients. CONCLUSIONS When using the single-site approach for appendectomy, obesity in children creates longer operative times, more doses of postoperative analgesics, longer length of stay, and greater charges. However, obesity has no impact on three-port appendectomy.
Collapse
Affiliation(s)
- E Marty Knott
- The Children's Mercy Hospital, Kansas City, Missouri 64108, USA
| | | | | | | | | |
Collapse
|
11
|
SILS: Is It Cost- and Time-Effective Compared to Standard Pediatric Laparoscopic Surgery? Minim Invasive Surg 2012; 2012:807609. [PMID: 22900165 PMCID: PMC3413955 DOI: 10.1155/2012/807609] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 06/21/2012] [Accepted: 06/21/2012] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to review our experience with single-incision laparoscopic surgery (SILS) and to compare costs and operative time to standard laparoscopic surgery (SLS). A prospectively collected database of operative times and costs was analysed for the years 2008–2011. SILS cases were compared to standard laparoscopy on a procedure-matched basis. Patient demographics, on-table time and consumable costs were collated. Descriptive statistics and Mann-Whitney U-test were utilized with SPSS for windows. Analysis of the data demonstrate that neither consumable costs nor operative time were significantly different in each group. Comparing operative costs, SILS appendicectomy, nephrectomy/heminephrectomy, and ovarian cystectomy/oophorectomy showed cost benefit over SLS (£397 versus £467; £942 versus £1127; £394 versus £495). A trend toward higher cost for SILS Palomo procedure is noted (£734 versus £400). Operative time for SILS appendicectomy, nephrectomy/heminephrectomy, and Palomo was lower compared to SLS (60 versus 103 minutes[mins.]; 130 versus 60 mins.; 60 versus 80 mins.). In conclusion, SILS appears to be cost-effective for the common pediatric surgical operations. There is no significant difference in operating time in this series, but small sample size is a limiting factor. Studies with larger numbers will be necessary to validate these initial observations.
Collapse
|