1185 “CLOSED” ACCESS IN PEDIATRIC UROLOGIC LAPAROSCOPY—A VIABLE ALTERNATIVE TO “OPEN” ACCESS IN A LARGE, CONTEMPORARY SERIES

Abstract

You have accessJournal of UrologyPediatrics: Reconstructive Surgery1 Apr 20111185 “CLOSED” ACCESS IN PEDIATRIC UROLOGIC LAPAROSCOPY—A VIABLE ALTERNATIVE TO “OPEN” ACCESS IN A LARGE, CONTEMPORARY SERIES Eric Nelson, Harsha Mittakanti, Shelly Bian, Kirk Jackson, David Roth, and Lars Cisek Eric NelsonEric Nelson Houston, TX More articles by this author , Harsha MittakantiHarsha Mittakanti Houston, TX More articles by this author , Shelly BianShelly Bian Houston, TX More articles by this author , Kirk JacksonKirk Jackson Houston, TX More articles by this author , David RothDavid Roth Houston, TX More articles by this author , and Lars CisekLars Cisek Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.818AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of laparoscopy in pediatric urologic surgery is now routine. Placement of the initial trocar is a critical step and avoidance of bowel and major vessel injury is paramount. The ideal technique for placement has not been explored in the pediatric urologic literature. We hypothesize that a “closed” access method is technically straight-forward, safe, and can be applied to routine pediatric urologic operations. METHODS An Institutional Review Board-approved retrospective chart review was performed of all patients undergoing laparoscopic surgery between 2003 and 2010. Data extracted included: age, procedure, previous surgical history, method and location of access, presence or absence of intra-abdominal adhesions, and intra-operative complications. Method of access was classified as either “open” (Hassan) or “closed” which included: the direct technique, optical access with a Visiport, or use of a Veress needle/Step Trocar system. For the direct access technique, an umbilical incision is made and the skin on either side is elevated in a “lifted table” technique. A bladeless trocar is then pushed and twisted with gentle, firm pressure through the rectus fascia. Intra-abdominal position is confirmed visually and the abdomen is then insufflated. In the Veress/Step Trocar group, a Veress needle confirmed intra-abdominal position and the timing of insufflation varied. RESULTS 668 encounters (631 patients) were identified and average age was 7.53 years (0.13–19.68). The procedures were performed by five surgeons and encompassed a variety of procedures (orchiopexy- related—179, inguinal hernia repair—180, varicocelectomy—160, ureteral reimplant—31, pyeloplasty—102). A “closed” access technique was utilized in 661/668 encounters (direct—475; Veress/Step—164; Visiport—20). 12.3% of the patients had a history of intra-abdominal surgery and significant adhesions were seen in 14 (2.1%). There was one complication during access—a small liver laceration during initial port placement for a pyeloplasty. The bleeding was minimal and required no intervention. An open technique was chosen in seven patients—five of these had concomitant umbilical hernia repair. CONCLUSIONS The “closed” technique for laparoscopic access in the pediatric population is safe and feasible even in patients with previous intra-abdominal surgery. We believe the technique is technically straight-forward and efficient. These data support “closed” access techniques as viable alternatives to the Hassan method for routine use in pediatric laparoscopy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e476 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Nelson Houston, TX More articles by this author Harsha Mittakanti Houston, TX More articles by this author Shelly Bian Houston, TX More articles by this author Kirk Jackson Houston, TX More articles by this author David Roth Houston, TX More articles by this author Lars Cisek Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...