Single Incision Pediatric Endoscopic Surgery: From Myth to Reality a Case Series

Single Incision Laparoscopic Surgery (SILS) in Small Animals: A Systematic Review and Meta-Analysis of Current Veterinary Literature

In veterinary surgery, single incision laparoscopic surgery (SILS) techniques have been described since 2009, and, in recent decades, many authors have reported the application of SILS in small animals, thus, promoting the wide dissemination of this novel approach among veterinary laparoscopists. The aim of this literature review is to provide a critical evaluation of the scientific reports on SILS in the field of small animal laparoscopic surgery. A comprehensive literature review was performed including from 1 January 2009 to 1 July 2020. The following data were recorded from each study: the design, year of publication, surgical procedure, species, number of animals included, and surgical time. The type of SILS technique and type of control group technique were evaluated. In total, 90 articles were identified through database searches and manual searches. The qualitative analysis showed that most of the articles were retrospective studies, without a control group or case series. A meta-analysis was performed on the eight controlled studies, showing that SILS ovariectomy and gastrointestinal procedures had a comparable surgical time to multiport techniques. The study of the articles available in the veterinary literature did not allow for an adequate meta-analysis of the published results, especially regarding post-operative pain, evaluations of surgical times, and post-operative complications in comparison to multiport techniques. Therefore, veterinary surgeons who want to employ these techniques must consider the real advantages of SILS techniques.

20 Years of Single-Incision-Pediatric-Endoscopic-Surgery: A Survey on Opinion and Experience Among International Pediatric Endosurgery Group Members

Aim/Background: Assessment of current role and future trends of Single-Incision-Pediatric-Endoscopic-Surgery (SIPES) in pediatric surgery among International Pediatric Endosurgery Group (IPEG) members two decades after introduction. Materials and Methods: An online survey was conducted between December 2019 and April 2020 on behalf of the IPEG Research Committee. All IPEG members were contacted by e-mail and asked to complete an anonymous questionnaire that included 39 items on SIPES. Results: One hundred eighty-four practicing pediatric surgeons completed the questionnaire from a pool of 890 IPEG members. The majority (76%) of respondents performed SIPES for more than 6 years with the following caseload per month: 1 case (31%), 2-5 cases (30%), 6-10 cases (24%), and >10 cases (17%). The four most commonly performed procedures were appendectomy (95%), Meckel diverticulectomy (55%), treatment of ovarian pathologies (43%), and U-stitch gastrostomy (40%). Complex reconstructive SIPES procedures were performed rarely. Most surgeons (95%) stated that better cosmesis is the predominant advantage of SIPES procedures. The majority of respondents (70%) felt that there is no convincing scientific evidence that SIPES offers benefits to multi-port minimally invasive procedures. Conclusion: Twenty years after introduction of SIPES, this technique has found its place in pediatric endoscopic surgery. Eighty percent of participating IPEG members of this survey apply SIPES for cases of lower complexity, such as appendectomy mainly for cosmetic reasons. The fact that 70% of respondents state that the scientific evidence for the benefits of SIPES is not convincing suggests that further studies and discussion on this technique are needed.

Establishment of Single-Port, Laparoscopic, Pediatric Hernia Repair in a Developing Country

Background: Single-port, laparoscopic, needle-assisted, inguinal hernia repair (LNAR) in children intends to reduce surgical trauma and enables contralateral assessment and closure of contralateral patent processus vaginalis if necessary. The aim of the present study was to demonstrate that laparoscopic inguinal repair can be performed safely and cost-effectively in a developing country where laparoscopy is not yet commonly used. Methods: In this single-center study, we included all children undergoing LNAR between January 2017 and December 2018. Intraoperative and postoperative complications and hospital costs were assessed. Results: We performed 148 hernia repair operations in 117 children (age range 1 month to 15 years). Mean operative time was 20.8 ± 9.4 minutes. Mean length of hospital stay amounted to 10 ± 7.6 hours, with 77.7% of patients discharged within 6 hours. No intraoperative complications occurred in any patient. Complications occurred in six (5.1%) patients. Three (2.5%) patients experienced residual hydrocele, two (1.4%) patients suffered wound site seroma, and one (0.67%) patient experienced recurrent inguinal hernia 6 months after the initial repair. All complications occurred during the first year of the study period. Likewise, operative time (P < .0001) as well as duration of hospital stay (P < .0001) was significantly shorter in the second year. Total costs for complete treatment were below USD 80 per patient, which is comparable with the costs associated with open herniotomy at the same institution. Conclusion: Single-port LNAR and hydrocele repair in children were established safely and cost-effectively in a developing country. Nevertheless, the procedure was associated with a steep learning curve.