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Single Incision Pediatric Endoscopic Surgery: From Myth to Reality a Case Series. ACTA ACUST UNITED AC 2019; 55:medicina55090574. [PMID: 31500274 PMCID: PMC6780980 DOI: 10.3390/medicina55090574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/27/2022]
Abstract
Laparoscopic surgery has continued to evolve to minimize access sites and scars in both the adult and pediatric populations. In children, single-incision pediatric endoscopic surgery (SIPES) has been shown to be effective, feasible, and safe with comparative results to multiport equivalents. Thus, the use of SIPES continues over increasingly complex cases, however, conceptions of its efficacy continue to vary greatly. In the present case series and discussion, we review the history of SIPES techniques and its current application today. We present this in the setting of five common myths about SIPES techniques: limitations against complex cases, restrictions to specialized training, increased morbidity outcomes, increased operative lengths, and increased operative costs. Regarding the myth of SIPES being limited in application to simple cases, examples were highlighted throughout the literature in addition to the authors’ own experience with three complex cases including resection of a lymphatic malformation, splenectomy with cholecystectomy, and distal pancreatectomy with splenectomy. A review of SIPES learning curves shows equivalent operative outcomes to multiport learning curves and advancements towards practical workshops to increase trainee familiarity can help assuage these aptitudes. In assessing comorbidities, adult literature reveals a slight increase in incisional hernia rates, but this does not correlate with single-incision pediatric data. In experienced hands, operative SIPES times average approximate multiport laparoscopic equivalents. Finally, regarding expenses, SIPES represents an equivalent alternative to laparoscopic techniques.
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Role of Laparoscopic Appendectomy Radix Ligation Techniques on the Formation of Inner Abdomen Abscess. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:164-168. [PMID: 32595392 PMCID: PMC7315095 DOI: 10.14744/semb.2017.92905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/20/2017] [Indexed: 11/23/2022]
Abstract
Objectives: Our aim was to study whether laparoscopic appendectomy radix ligation techniques were eutrophic in the development of intra-abdominal abscess. Methods: Between September 2009 and April 2017, all emergency cases admitted to our surgery polyclinic were reviewed, and the results of the patients who underwent laparoscopic appendectomy were collected. Appendectomy radix ligation techniques were reviewed from surgical notes on discharge reports. Postoperative controls were also reviewed, and any cases with abscess formation were reported. Results: A total of 350 patients were included in the study. Of these cases, 207 were males, and 143 were females. The mean age of the patients was 26.89±4.9 years. One hundred eighty-nine cases were found to have two endoloops placed on top of each other, whereas 161 cases had a 2 mm distance left in between the two endoloops and tied. None of the 189 cases who had endoloops placed on top of each other developed abscess formation. However, of the 161 cases who had endoloops with a 2 mm distance in between, 8 reported with abscess formation in the inner abdomen. Of these eight cases, seven had percutaneous abscess drainage by an interventional radiologist, whereas one was treated with relaparoscopy. Conclusion: In the present study, patients who had endoloops placed on top of each other developed no abscess formation, whereas in the literature’s gold standard procedure, those with a 2 mm distance left between two endoloops developed an inner abdominal abscess formation in 8 (4.9%) of the patients. We believe that this 2 mm dead space distance left between the two endoloops contributes to the formation of the abscess.
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Seifarth FG, Kundu N, Guerron AD, Garland MM, Gaffley MWG, Worley S, Knight CG. Umbilical Negative Pressure Dressing for Transumbilical Appendectomy in Childern. JSLS 2017; 20:JSLS.2016.00070. [PMID: 27807398 PMCID: PMC5081401 DOI: 10.4293/jsls.2016.00070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives: Transumbilical laparoscopic-assisted appendectomy (TULAA) carries a high risk for surgical site infection. We investigated the effect of a bio-occlusive umbilical vacuum dressing on wound infection rates after TULAA for patients with acute appendicitis and compared to it with a conventional 3-port appendectomy with a nonvacuum dressing. Methods: This study was a retrospective chart review of 1377 patients (2–20 years) undergoing laparoscopic appendectomy for acute appendicitis in 2 tertiary care referral centers from January 2007 through December 2012. Twenty-two different operative technique/dressing variations were documented. The 6 technique/dressing groups with >50 patients were assessed, including a total of 1283 patients. Results: The surgical site infection rate of the 220 patients treated with TULAA and application of an umbilical vacuum dressing with dry gauze is 1.8% (95% CI, 0.0–10.3%). This compares to an infection rate of 4.1% (95% CI, 1.3–10.5%) in 97 patients with dry dressing without vacuum. In the 395 patients who received an umbilical vacuum dressing with gauze and bacitracin, the surgical site infection rate was found to be 4.3% (95% CI, 2.7–6.8%). Conclusions: Application of an umbilical negative-pressure dressing with dry gauze lowers the rate of umbilical site infections in patients undergoing transumbilical laparoscopic-assisted appendectomy for acute appendicitis.
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Affiliation(s)
- Federico G Seifarth
- Department of Pediatric Surgery, Kalispell Regional Healthcare, Kalispell, Montana, USA
| | | | | | - Mary M Garland
- Department of Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Michaela W G Gaffley
- Department of Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Sarah Worley
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Colin G Knight
- Department of Pediatric Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
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TULAA: A Minimally Invasive Appendicectomy Technique for the Paediatric Patient. Minim Invasive Surg 2017; 2016:6132741. [PMID: 28078139 PMCID: PMC5203905 DOI: 10.1155/2016/6132741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/20/2016] [Indexed: 12/29/2022] Open
Abstract
TULAA or Transumbilical Laparoscopic Assisted Appendicectomy is a minimally invasive technique described by Pelosi in 1992 for the removal of the inflamed appendix. Its main advantage is the possibility of exploring the peritoneal cavity and performing a simple and safe extracorporeal appendicectomy. Since its first description, different authors reported their experience with such technique. The aim of this review is to summarise the surgical outcomes currently reported in the literature for this minimally invasive surgical approach and compare it with standard open and laparoscopic appendicectomy.
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Abstract
BACKGROUND Abscess rates have been reported to be as low as 1% and as high as 50% following perforated appendicitis (PA). This range may be because of lack of universal definition for PA. An evidence-based definition (EBD) is crucial for accurate wound classification, risk-stratification, and subsequent process optimization. ACS NSQIP-Pediatric guidelines do not specify a definition of PA. We hypothesize that reported postoperative abscess rates underrepresent true incidence, as they may include low-risk cases in final calculations. METHODS Local institutional records of PA patients were reviewed to calculate the postoperative abscess rate. The ACS NSQIP-Pediatric participant use file (PUF) was used to determine cross-institutional postoperative abscess rates. A PubMed literature review was performed to identify trials reporting PA abscess rates, and definitions and rates were recorded. RESULTS 20.9% of our patients with PA developed a postoperative abscess. The ACS NSQIP-Pediatric abscess rate was significantly lower (7.61%, p<0.001). In the eighteen published studies analyzed, average abscess rate (14.49%) was significantly higher than ACS NSQIP-Pediatric (p<0.001). There was significantly more variation in trials that do not employ an EBD of perforation (Levene's test F-value =6.980, p=0.018). CONCLUSIONS A standard EBD of perforation leads to lower variability in reported postoperative abscess rates following PA. Nonstandard definitions may be significantly altering the aggregate rate of postoperative abscess formation. We advocate for adoption of a standard definition by all institutions participating in ACS NSQIP-Pediatric data submission. LEVEL OF EVIDENCE III.
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Litz CN, Farach SM, Danielson PD, Chandler NM. Obesity and single-incision laparoscopic appendectomy in children. J Surg Res 2016; 203:283-6. [PMID: 27363633 DOI: 10.1016/j.jss.2016.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/11/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Single-incision laparoscopic appendectomy (SILA) has emerged as a less-invasive alternative to conventional laparoscopy. The purpose of this study was to assess the impact of body habitus on outcomes after SILA in the pediatric population. METHODS A retrospective review of 413 patients who underwent SILA from 2012 to 2015 was performed. Body mass index (BMI) was calculated, and the BMI percentile was obtained per Center for Disease Control guidelines. Standard definitions for overweight (BMI 85th-94th percentile) and obese (BMI > 95th percentile) were used. General demographic and outcome data were analyzed. RESULTS SILA was performed in 413 patients during the study period, of which 66.3% were normal weight, 16% were overweight, and 17.7% were obese. There were no significant differences in age at presentation, time to diagnosis, or intraoperative classification of appendicitis. There were no significant differences in operative time (27.0 ± 9.1 versus 27 ± 9.8 versus 28.4 ± 9.4 min, P = 0.514), postoperative length of stay (0.97 ± 1.65 versus 1.53 ± 4.15 versus 1.14 ± 2.27 d, P = 0.214), 30-d surgical site infections (6.9% versus 12.1% versus 8.2%, P = 0.377), emergency department visits (8.4% versus 10.6% versus 11%, P = 0.726), or readmissions (4.7% versus 4.1% versus 4.5%, P = 0.967) among normal, overweight, and obese groups. CONCLUSIONS Our results indicate that obesity does not significantly impact outcomes after SILA. SILA can be performed in overweight and obese children with no significant difference in operative time, length of stay, or incidence of surgical site infection. SILA should continue to be offered to overweight and obese children.
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Affiliation(s)
- Cristen N Litz
- Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, St Petersburg, Florida.
| | - Sandra M Farach
- Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, St Petersburg, Florida
| | - Paul D Danielson
- Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, St Petersburg, Florida
| | - Nicole M Chandler
- Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, St Petersburg, Florida
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Gorter RR, Heij HA, Eker HH, Kazemier G. Laparoscopic appendectomy: State of the art. Tailored approach to the application of laparoscopic appendectomy? Best Pract Res Clin Gastroenterol 2014; 28:211-24. [PMID: 24485267 DOI: 10.1016/j.bpg.2013.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/23/2013] [Indexed: 02/07/2023]
Abstract
Acute appendicitis is the most common surgical emergency in developed countries. The treatment of acute appendicitis is either open or laparoscopic appendectomy. The latter has gained wide acceptance in the past years, although the debate on the true merits of laparoscopic appendectomy is still on going. Some authors prefer this approach as the gold standard for all patients, but in our opinion a tailored approach is warranted for specific patient groups. In addition, a standardised guideline on the technical aspects is still lacking. In the current article, open versus laparoscopic appendectomy and several technical aspects, such as stump closure, appendix extraction and single incision are discussed laparoscopic appendectomy are being addressed. In the future perspectives we will briefly discuss the third 'newly' introduced antibiotic treatment.
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Affiliation(s)
- Ramon R Gorter
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Vondellaan13, 1942 LE Beverwijk, The Netherlands.
| | - Hugo A Heij
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
| | - Hasan H Eker
- Department of Surgery, Red Cross Hospital, Vondellaan13, 1942 LE Beverwijk, The Netherlands; Department of Surgery, VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
| | - Geert Kazemier
- Department of Surgery, VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
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Laparoscopic-assisted single-port appendectomy in children: it is a safe and cost-effective alternative to conventional laparoscopic techniques? Minim Invasive Surg 2014; 2013:165108. [PMID: 24381754 PMCID: PMC3870869 DOI: 10.1155/2013/165108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 10/04/2013] [Indexed: 01/04/2023] Open
Abstract
Aim. Laparoscopic-assisted single-port appendectomy (SPA), although combining the advantages of open and conventional laparoscopic surgery, is still not widely used in childhood. The aim of this study was to evaluate the safety and the cost effectiveness of SPA in children. Methods. After institutional review board approval, we retrospectively evaluated 262 children who underwent SPA. The appendix was dissected outside the abdominal cavity as in open surgery. For stump closure, we used two 3/0 vicryl RB-1 sutures. Results. We identified 146 boys (55.7%) and 116 girls (44.3%). Median age at operation was 11.4 years (range, 1.1–15.9). Closure of the appendiceal stump using two sutures (cost: USD 15) was successful in all patients. Neither a stapler (cost: USD 276) nor endoloops (cost: USD 89) were used. During a follow-up of up to 69 months (range, 30–69), six obese children (2.3%, body mass index >95th percentile) developed an intra-abdominal abscess after perforated appendicitis. No insufficiency of the appendiceal stump was observed by ultrasound. Five of them were treated successfully by antibiotics, one child required drainage. Conclusion. The SPA technique with conventional extracorporal closure of the appendiceal stump is safe and cost effective. In our unit, SPA is the standard procedure for appendectomy in children.
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Yannam GR, Griffin R, Anderson SA, Beierle EA, Chen MK, Harmon CM. Single incision pediatric endosurgery (SIPES) appendectomy--is obesity a contraindication? J Pediatr Surg 2013; 48:1399-404. [PMID: 23845637 DOI: 10.1016/j.jpedsurg.2013.03.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/09/2013] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Single-incision pediatric endosurgery (SIPES) is gaining popularity and has been reported to be safe in acute (non-perforated) and perforated appendicitis. The feasibility of SIPES appendectomy in obese children is uncertain. MATERIALS AND METHODS After IRB approval, data were collected from a prospectively maintained SIPES appendectomy database for cases performed between April 2009 and March 2012. Patients were divided into obese and non-obese groups based on Center for Disease Control criteria. The surgical techniques, operative times, complications, conversion rates, and outcomes were recorded. Chi-square test and t-test were used for statistical analysis. RESULTS SIPES appendectomy was attempted in 500 children. There were 21% obese, and 37% were female with median age of 10.9 ± 3.8 years. Mean operative time, blood loss, requirement of additional trocars, and intraoperative complications in non-obese and obese children were not significantly different. Mean hospital stay (2.3 days in each group), post operative wound infections (3.3% vs. 4.8%, p=0.55, non-obese vs. obese), and intraabdominal abscesses (4.3% vs. 2.9%, p=0.77, non-obese vs. obese) were not significantly different. CONCLUSION SIPES appendectomy may be accomplished successfully and safely in obese children. Obesity did not appear to be associated with increased risk of complications and was not a contraindication for SIPES appendectomy.
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Affiliation(s)
- Govardhana R Yannam
- Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
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Saldaña LJ, Targarona EM. Single-incision pediatric endosurgery: a systematic review. J Laparoendosc Adv Surg Tech A 2013; 23:467-80. [PMID: 23560658 DOI: 10.1089/lap.2012.0467] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Single-incision pediatric endosurgery (SIPES) is defined as minimally invasive surgery performed through a unique incision in the abdomen, chest, or retroperitoneum. Several publications exist, but no previous systematic review has been made to evaluate the real benefits of this approach in terms of feasibility and clinical outcomes. MATERIALS AND METHODS We performed an electronic search in PubMed up to March 2012 with the terms "single AND incision OR site OR port OR trocar AND children" including related articles and obtained 197 articles. After applying our inclusion criteria, 78 articles were reviewed. RESULTS We identified prospective controlled trials (n=1), case-control studies (n=12), case series (n=49), and case reports (n=16). In total, 4212 patients had been operated on by SIPES and were separated by systems: gastrointestinal (n=2888), urologic (n=390), gynecologic (n=27), other abdominal (n=874), and thoracic (n=33) procedures. The most common procedure was SIPES appendectomy, and a unique prospective controlled trial supports its safety and effectiveness. Technically demanding surgeries such as hepatojejunostomy and colonic surgeries were described. Multichannel ports and multiple ports, standard and articulated instruments, transparietal instruments, retraction sutures, and magnets were used. Operative times, length of stay, and complications similar to standard laparoscopic surgery were described. A low conversion rate (to a reduced port, standard laparoscopy and open procedures) was also mentioned. No comparable measure for pain and cosmesis assessment was used. CONCLUSIONS A wide experience in SIPES and feasibility has already been described with good clinical outcomes and low rate of conversion. Appendectomy is the unique procedure in which SIPES has been demonstrated to be safe and effective. It is pending the execution of prospective controlled trials for other operations to demonstrate, with objective evidence, the real benefits of this less invasive approach.
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Affiliation(s)
- Lily J Saldaña
- Department of Pediatric Surgery, Institute of Child Health, Lima, Peru.
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Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Curr Probl Surg 2013; 50:54-86. [PMID: 23374326 DOI: 10.1067/j.cpsurg.2012.10.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kye BH, Lee J, Kim W, Kim D, Lee D. Comparative study between single-incision and three-port laparoscopic appendectomy: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 2013; 23:431-6. [PMID: 23473061 DOI: 10.1089/lap.2012.0284] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery is a new procedure used to treat a variety of diseases requiring surgical intervention. The aim of this prospective comparative study is to compare the technical feasibility and safety of single-incision and three-port laparoscopic appendectomy. STUDY DESIGN Between February 2009 and April 2010, 102 patients with appendicitis were enrolled in this study. The patients were randomly assigned to two groups: single-incision or three-port laparoscopic appendectomy. Patients with perforated appendicitis were not excluded. We analyzed the patients' clinical characteristics and surgical outcomes. RESULTS There were no significant differences in preoperative patient demographics between the two groups with respect to body mass index (22.03±4.07 kg/m(2) in the single-incision group versus 21.97±3.49 kg/m(2) in the three-port group, P=.930). The pain score on the visual analog scale on postoperative Day 1 was significantly lower in the single-incision group than in the three-port group (3.22±1.22 versus 3.90±1.46, P=.012). Additionally, recovery time to daily life was significantly shorter in the single-incision group than in the three-port group (3.22±1.04 versus 3.94±1.43 days, P=.005). In patients with perforated appendicitis, the single-incision procedure took approximately 10 minutes less than the three-port procedure (44.11±7.75 versus 54.14±32.21 minutes, P=.449), and the postoperative hospital stay (P=.033) and recovery time to daily life (P=.001) were significantly shorter in the single-incision group. CONCLUSIONS Single-incision laparoscopic appendectomy is a feasible and safe procedure, even in patients with perforated appendicitis, and this procedure is even less invasive than three-port laparoscopic surgical techniques.
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Affiliation(s)
- Bong-Hyeon Kye
- Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
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Rehman H, Mathews T, Ahmed I. A review of minimally invasive single-port/incision laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A 2013; 22:641-6. [PMID: 22954028 DOI: 10.1089/lap.2011.0237] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Single-port/incision laparoscopic appendectomy (SPILA) is a modern advancement toward stealth surgery, using a single point of entry. Despite the paucity of clinical data, it is increasingly being used to minimize scarring and, potentially, pain associated with the multiple entry points. We aimed to summarize and present available data on this new approach. METHODOLOGY All available databases until December 2010 including the Cochrane Controlled Trials Register, MEDLINE, and EMBASE were searched and cross-referenced for studies describing single-incision laparoscopic appendectomy. Case and experimental reports, series with fewer than 5 patients, and non-English articles were excluded. Outcome measures were operative time, postoperative hospital stay, pain scores, complications, conversion, and mortality, stratified according to type of SPILA approach. SPSS version 18.0.0 software was used for data collection. RESULTS Database query yielded 79 articles; 45 were included (1 randomized controlled trial, 44 case series). Total cases were 2806, with mean patient age for studies ranging from 7.0 to 37.5 years. No mortality was reported. The overall complication rate was 4.13%. The overall weighted mean operating time was 41.3 minutes (range, 15.0-95.9 minutes). The weighted mean hospital stay was 2.79 days (range, 1.0-6.6 days). CONCLUSIONS Although the incidence of complications with SPILA remains low and operating times between new and traditional approaches are comparable in case-based literature, adequately powered randomized trials are required to assess its effectiveness. Occurrence of long-term complication types remains unexplored.
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Affiliation(s)
- Haroon Rehman
- University of Aberdeen, Aberdeen, Scotland, United Kingdom.
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Vanderlinden K, Van De Winkel N, De Backer A, Delvaux G, De Vogelaere K. Early experience with single-incision laparoscopic surgery for the placement of a gastrostomy in a 10-year-old girl: a case report. J Med Case Rep 2012; 6:375. [PMID: 23130674 PMCID: PMC3514111 DOI: 10.1186/1752-1947-6-375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 09/06/2012] [Indexed: 12/30/2022] Open
Abstract
Introduction Access procedures for alimentation have been performed both endoscopically and surgically. In patients in whom endoscopic gastrostomy feeding tubes cannot be placed, single-incision laparoscopic surgery gastrostomy is an alternative method. This minimally invasive approach is a new technique performed through a single umbilical incision and without the need for additional laparoscopic ports. Case presentation In this article we present a case of single-incision laparoscopic surgery gastrostomy performed with conventional laparoscopic instruments in a 10-year-old girl of Caucasian ethnicity who was not a candidate for a percutaneous endoscopic gastrostomy tube because of esophageal varices due to her advanced-stage cystic fibrosis with liver cirrhosis and portal hypertension. She also had an umbilical hernia, which was repaired during the same procedure through the same incision. Access and pneumoperitoneum were obtained through the umbilicus with the single-incision laparoscopic surgery port. The selected site for the feeding tube in the stomach was exteriorized through this incision and a feeding tube was placed. The stomach was returned into the abdomen. The fascial defect, and thus also the hernia, was repaired, and the 2cm umbilical incision was closed with endocutaneous sutures. The total operative time was 25 minutes. Our patient’s intra-operative and post-operative course was uneventful. We were able to use the feeding tube on the first post-operative day with good intestinal function. Our patient and her parents were pleased with the cosmetic result. Conclusions The single-incision laparoscopic surgery procedure seems to be a less invasive alternative to open placement of gastrostomy. This approach has the possible advantages of reduced post-operative pain, faster return to normal function, reduced port site complications, improved cosmesis and better patient satisfaction.
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Affiliation(s)
- Kim Vanderlinden
- Department of Abdominal and Pediatric Surgery, UZ Brussel, Brussels, Belgium.
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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.
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Affiliation(s)
- E Marty Knott
- The Children's Mercy Hospital, Kansas City, Missouri 64108, USA
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Single-port laparoscopic surgery in children: concept and controversies of the new technique. Minim Invasive Surg 2012; 2012:232347. [PMID: 22778945 PMCID: PMC3384965 DOI: 10.1155/2012/232347] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 03/30/2012] [Accepted: 04/11/2012] [Indexed: 12/18/2022] Open
Abstract
Single-incision laparoscopic surgery (SILS) is emerging as an alternative technique to conventional laparoscopy for the treatment of common surgical diseases. Despite its wide use, the adoption of SILS in children has been slower since the broad application of minimally invasive techniques in children, in general, has historically lagged behind those in adults. This paper reviews the evolution of SILS from its original conception and its application in the field of pediatric surgery.
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Rehman H, Ahmed I. Technical approaches to single port/incision laparoscopic appendicectomy: a literature review. Ann R Coll Surg Engl 2011; 93:508-13. [PMID: 22004632 PMCID: PMC3604919 DOI: 10.1308/147870811x13137608455091] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2011] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Single port/incision laparoscopic surgery (SPILS) is a modern advancement toward stealth surgery. Despite the paucity of high-quality scientific studies assessing its effectiveness, this procedure is being used increasingly. This review aims to describe commonly used techniques for SPILS appendicectomies (SPILA), to summarise complication rates in the literature and to provide discussion on indications and implementation. METHODS All available databases including the Cochrane Central Register of Controlled Trials, MEDLINE(®) and Embase™ were searched in February 2011 and cross-referenced for available English literature describing SPILA in patients of any age. RESULTS Three broad technical approaches are described: procedures using laparoscopic instruments through a single skin incision in the abdominal wall, regardless of the number of fascial incisions, with or without the additional use of percutaneous sutures or wires to 'assist' the operation, and hybrid procedures, in which the appendix is exteriorised using a single incision laparoscopically assisted operation but subsequently divided using a conventional 'open' appendicectomy technique. Complication rates seem to be highest in SPILA procedures unassisted by sutures or wires. CONCLUSIONS Future research assessing the efficacy of single incision laparoscopic procedures should consider variation in technique as a possible factor affecting outcome.
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Affiliation(s)
- H Rehman
- Department of Hepatopancreatobiliary Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK.
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Ohno Y, Morimura T, Hayashi SI. Transumbilical laparoscopically assisted appendectomy in children: the results of a single-port, single-channel procedure. Surg Endosc 2011; 26:523-7. [PMID: 21938576 DOI: 10.1007/s00464-011-1912-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 07/20/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Even for pediatric patients, the use of laparoscopic appendectomy has been widely accepted, and three trocars usually are necessary to perform a laparoscopic appendectomy. However, single-port appendectomy for children represents an attractive alternative. To reduce the number of incisions and trocars, the authors have adopted a transumbilical laparoscopically assisted single-port appendectomy (TULAA) approach. This study aimed to evaluate the results of their single-channel, single-port appendectomy. METHODS A retrospective study of TULAA was performed during 12 years with 500 children ages 2-16 years (median, 10.2 years). The TULAA approach is a single-channel surgery using a 12 mm conventional single-port. The vertical incision through the umbilicus is used for laparoscopic access. Two laparoscopic instruments, a 5 mm telescope and a 5 mm grasper, are inserted simultaneously into the single-channel. The grasper holds the base of the appendix, and the appendix is exteriorized through the umbilical incision. Thereafter, a conventional appendectomy is performed extracorporeally. RESULTS The TULAA procedure was successful for 416 patients (83.2%). These successful TULAA procedures required a mean surgery time of 44.5 min. The pathologic diagnosis of the appendix was acute for 59 patients, phlegmonous for 203 patients, gangrenous for 152 patients, and not detected for two patients. Complications occurred for 47 of these patients (11.3%). Most of the complications were associated with severe intraabdominal inflammation. Two patients needed reoperation under general anesthesia. Conversion to multitrocar surgery or open appendectomy was performed for 84 of the patients (16.8%). CONCLUSIONS The TULAA procedure is a preferable operation for acute appendicitis in children because it is simple and provides good cosmetic results.
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Affiliation(s)
- Yasuharu Ohno
- Department of Pediatric Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
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Rehman H, Rao AM, Ahmed I. Single incision versus conventional multi-incision appendicectomy for suspected appendicitis. Cochrane Database Syst Rev 2011:CD009022. [PMID: 21735437 DOI: 10.1002/14651858.cd009022.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Appendicectomy is a well established surgical procedure used in the management of acute appendicitis. The operation can be performed with minimally invasive surgery (laparoscopic) or as an open procedure. A recent development in appendicectomy has been the introduction of less invasive single incision laparoscopic surgery, using a single multi-luminal port or multiple mono-luminal ports, through a single skin incision. There are yet unanswered questions regarding the efficacy of this new and novel technique including: patient benefit and satisfaction, complications, long-term outcomes, and survival. OBJECTIVES The aim of this review is to perform meta-analysis using data from available trials comparing single incision with conventional multi-incision laparoscopic appendicectomy for appendicitis, in order to ascertain any differences in outcome. SEARCH STRATEGY We searched the electronic databases including MEDLINE/PubMed (from 1980 to December 2010), EMBASE/Ovid (from 1980 to December 2010) and CENTRAL (The Cochrane Library 2010, Issue 11) with pre-specified terms. We also searched reference lists of relevant articles and reviews, conference proceedings and ongoing trial databases. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of patients with appendicitis, or symptoms of appendicitis, undergoing laparoscopic appendicectomy, in which at least one arm involves single incision procedures and another multi-incision procedures. DATA COLLECTION AND ANALYSIS There were no RCTs or prospectively controlled trials found that met the inclusion criteria. MAIN RESULTS Three authors performed study selection independently.No studies that met the inclusion criteria of this review were identified. Current evidence exists only the form of case-series.This review has been authored as 'empty' pending the results of 5 ongoing trials. AUTHORS' CONCLUSIONS No RCTs comparing single incision laparoscopic appendectomy with multi-incision surgery could be identified. No definitive conclusions can be made at this time. Well designed prospective RCTs are required in order to evaluate benefit or harm from laparoscopic surgical approaches for appendicectomy. Until appropriate data has been reported, the institutional polices of healthcare providers must be based on the clinical judgement of experts in the field.
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Affiliation(s)
- Haroon Rehman
- General Surgery, University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZD
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Cobellis G, Torino G, Noviello C, Cruccetti A, Mastroianni L, Amici G, Martino A. Versatility of one-trocar surgery in children. J Laparoendosc Adv Surg Tech A 2011; 21:549-54. [PMID: 21443436 DOI: 10.1089/lap.2010.0063] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/PURPOSE One-trocar surgery (OTS) includes all video-surgical techniques performed using a single 10-mm port and an operative scope. These techniques can be completely endoscopic or endoscopic assisted. Since 1997, OTS has become the approach of choice in our institution for a variety of laparoscopic, retroperitoneoscopic, and thoracoscopic operations. We report our experience with this technique. METHODS Four hundred fifty-eight patients (age range, 3 months to 17 years) underwent OTS from October 1997 to December 2008. The procedures were transumbilical laparoscopic-assisted (TULA) appendectomy (182 patients), TULA small bowel resection (14 patients), TULA intestinal biopsies (7 patients), laparoscopic adhesiolysis (6 patients), laparoscopic-assisted liver biopsies (5 patients), laparoscopic revision of peritoneal dialysis catheter (3 patients), retroperitoneoscopic varicocelectomy (202 patients), retroperitoneoscopic-assisted renal biopsies (4 patients), retroperitoneoscopic drainage of posttraumatic urinoma (1 patient), retroperitoneoscopic-assisted pyeloplasty (15 patients), and thoracoscopic pleural debridement and decortication for empyema (19 patients). RESULTS The procedure was completed using only one trocar in 399 cases (87.1%). All conversions to multitrocar or open surgery were elective and regarded the retroperitoneoscopic approach during the learning curve (28 of 222, 12.6%; 21 varicocelectomies and 7 pyeloplasties) and the TULA appendectomy because of the appendix mobilization failure (31 of 182, 17%). There were no intraoperative or postoperative complications related to OTS. Wound infection was observed after two TULA appendectomies (1.3%). CONCLUSIONS According to our experience, OTS is a feasible and versatile technique in pediatric surgery, providing a safe, effective, and the least invasive treatment for several different diseases.
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Affiliation(s)
- Giovanni Cobellis
- Paediatric Surgical Unit, Salesi Children's Hospital, University Politecnica delle Marche, Ancona, Italy.
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