Laparoendoscopic Single-Site Surgery for Pediatric Urologic Disease

Advantages of single-site laparoscopic orchiopexy for palpable undescended testes in children: a prospective comparison study

PURPOSE

To evaluate the feasibility of single-site laparoscopic orchiopexy for palpable undescended testes in children.

METHODS

We prospectively studied patients with undescended testes between July 2021 and June 2022. In total, 223 patients were included in our study: 105 underwent single-site laparoscopic orchiopexy and 118 underwent conventional laparoscopic orchiopexy. During single-site laparoscopic orchiopexy, 3 ports were inserted within the umbilicus.

RESULTS

No differences were observed between the groups in terms of age and laterality. For unilateral undescended testes, the operating time was longer in the single site group than in the conventional group at the early stages (55.31 ± 12.04 min vs. 48.14 ± 14.39 min, P = 0.007), but it was similar to the conventional group at the later stages (48.82 ± 13.49 min vs. 48.14 ± 14.39 min, P = 0.78). Testicular ascent occurred in one patient from each group. There was no significant difference in the success rate between the single-site group and the conventional group (99.0% vs. 99.2%, P = 0.93). In the single-site group, no visible abdominal scarring was observed, while in the conventional group, there were two noticeable scars on the abdomen.

CONCLUSION

Single-site laparoscopic orchiopexy offers superior cosmetic results and comparable success rates compared to conventional laparoscopic orchiopexy for palpable undescended testes.

Bibliometric and Visual Analysis of the Current Status and Trends of Postoperative Pain in Children from 1950-2021

Background

Postoperative pain in children has been overlooked for a long time. The knowledge structure, research hotspots and trends related to postoperative pain in children are unclear and have not been systematically summarized.

Purpose

We aimed to analyze the current state of research on postoperative pain in children and to conduct in-depth mining of the knowledge structure.

Methods

The PubMed database for publications on postoperative pain in children between 1950 and 2021 was searched. Bibliographic Item Co-Occurrence Matrix Builder (BICOMB) was performed to obtain the co-word matrix and co-occurrence matrix. The H-index method was used to extract high-frequency main Medical Subject Headings (MeSH) terms/subheadings.

Results

The high-frequency MeSH terms were analyzed by biclustering, strategic diagram and social network analyses. Totally, 4022 publications were retrieved. The analysis showed that 60 countries or regions published relevant documents, with the United States publishing the most significant number of papers. Totally, 811 journals published relevant papers, with Pediatric Anesthesia ranking first. Moreover, we extracted 43 high-frequency main MeSH terms/subheadings and clustered them into five categories: overview, aetiology and epidemiology, pharmacotherapy, opioid administration and dosing, and prevention and control of postoperative pain in children.

Conclusion

Pharmacological treatments, pain prevention and control are the focus of research and are becoming increasingly mature. Opioid stewardship and regional anesthesia is the trend and focus of future research. Our study offers a better understanding of the current status and knowledge structure of postoperative pain in children and provides a reference for improving postoperative pain management in children in the future.

Robot-assisted laparoscopic single-port pyeloplasty using the da Vinci SP® system: initial experience with a pediatric patient

INTRODUCTION

The da Vinci SP® Robotic Surgical Platform (Intuitive Surgical) was recently introduced to overcome triangulation and motion restriction during laparoendoscopic single-site surgery. The authors describe a pure, single-site, robot-assisted, laparoscopic pyeloplasty (RALP) using the da Vinci SP System in a pediatric patient.

MATERIAL AND METHODS

A 10-year-old patient with ureteropelvic junction obstruction underwent pyeloplasty conducted using the da Vinci SP® System. Retrospective perioperative and immediate postoperative outcomes were investigated.

RESULTS

Surgery was completed with pure single-site surgery without additional port placement or standard multiport conversion. The total operation time was 211 min, and the console time was 90 min. The docking time was much greater than that of previous pyeloplasty operations using multiport system. This result may be because of difficulties caused by bulky instrumentation entering the pneumoperitoneum. The estimated blood loss was minor, and there were no intraoperative or perioperative complications. Ureteral stent was removed after 4 weeks. Cosmetic outcomes were satisfactory.

CONCLUSIONS

Pure, single-site RALP using da Vinci SP® System seems feasible in aging children. Additional studies involving more patients, younger children, and long-term outcomes are required.

Laparoscopic nephroureterectomy using the stoma site of cutaneous ureterostomy as a multi-channel port site in a 15-month-old child with megaureter: A case report

He was born with markedly dilated left megaureter. Since it disturbed his oral intake after birth, left temporary cutaneous ureterostomy was created at 3 days of age. Since his left kidney was dysplastic, laparoscopic left nephroureterectomy was performed using the stoma site of cutaneous ureterostomy as a multi-channel port site at 15 months of age. He had no complications after surgery, and the postoperative wound appearance was good.

This is the first report of the stoma site being used as a multi-channel port site in the urology field. This surgical approach provides good cosmetic outcomes.

Laparoendoscopic Single-Site (LESS) Surgery in Pediatric Urology: A 4-Year Experience

Objective

The aim of the study was to assess the feasibility and outcomes of pediatric urological laparoendoscopic single-site (LESS) surgery.

Materials and Methods

We retrospectively collected charts of all patients who underwent LESS procedures in our department from January 2013 to December 2016. Data included demographic characteristics, type of procedures, intraoperative details, hospital stay, and complications. The umbilicus was used as the surgical site in all cases. All procedures were performed with a homemade glove port and standard straight 3- or 5-mm laparoscopic instruments.

Results

Seventy-three patients (55 males, 18 females) were identifed. Procedures included 46 orchidop-exies, 21 pyeloplasties, 8 varicocelectomies, 3 nephrecto-mies, 3 nephroureterectomies, 3 orchiectomies, and 1 renal hydatid cyst treatment. Median operative time for the entire cohort was 47 min (range 26-156 min). There was no signifcant intraoperative blood loss. No conversion to conventional laparoscopy or open surgery was needed. All patients required paracetamol postoperatively. The mean follow-up was 18 months. Two patients had testicular atrophy after a Fowler-Stephens procedure and 1 patient had testicular reascension. Cosmetic results were excellent. Forty-five (62.5%) patients were discharged on the day of surgery.

Conclusion

Our study demonstrated that LESS surgery using our glove port technique and conventional laparoscopic instruments is a feasible and safe technique for the surgical management of various pediatric urological conditions.

Laparoendoscopic single-site surgery (LESS) for major urological procedures in the pediatric population: A systematic review

BACKGROUND

Improvements in laparoscopic surgery have led to the introduction of laparoendoscopic single-site surgery (LESS) as an alternative to conventional laparoscopy conferring a number of possible advantages. In this review, we aim to elucidate the aspects of LESS for major urological procedures in the pediatric population.

MATERIALS AND METHODS

An in-depth search of the literature was performed in the databases of PubMed and Scopus, for studies investigating the technical aspects and clinical outcomes of partial nephrectomies, nephrectomies, nephroureterectomies, varicocelectomies and pyeloplasties in children. Data on parameters such as operation time, instrumentation, perioperative complications, hospital stay and follow up period were collected and further analyzed cumulatively.

RESULTS

Twenty nine studies met the inclusion criteria incorporating 386 patients who underwent 401 procedures. There were no major intraoperative complications, with only 19 patients (4.73%) facing postoperative complications. No perioperative deaths were reported.

CONCLUSIONS

In the hands of experienced surgeons LESS seems a feasible, efficient and less invasive alternative to standard laparoscopy in the field of pediatric urology. There is an eminent need of well-designed randomized controlled trials comparing the two techniques.