Cholecystectomy Using Single-Incision Pediatric Endosurgery: Technique and Initial Experience in the First 25 Cases

Abstract

Laparoscopic cholecystectomy has become the standard, in most pediatric surgery centers. In the search for a less-invasive procedure, a single-incision laparoscopic approach has been reported in adults and very few children. The aim of this study was to present our initial experience of cholecystectomy, using single-incision pediatric endosurgery (SIPES), including the technique, the intraoperative challenges, and the outcome. All pediatric patients who underwent a SIPES cholecystectomy from March through September 2009 were prospectively evaluated. Twenty-five children underwent a SIPES cholecystectomy. The most frequent indications were symptomatic cholelithiasis in 17 patients (68%) and biliary dyskinesia in 5 (20%). Five patients had sickle-cell anemia. The mean operative time was 73 minutes (range, 30-122). Median hospital stay was 1 day. In 17 patients (68%), a percutaneous 2-mm grasper was used to retract the gallbladder over the liver. No complications were noted, and no conversion to an open procedure was required. In 5 patients, additional trocars were added. On follow-up, 3 days to 2 months later, no complications were noted. No patients were readmitted, and there were no wound infections. Cholecystectomy, when using the SIPES approach in children, is a safe, reasonable alternative to conventional laparoscopy, leaving an inconspicuous scar. Whether SIPES offers any further benefit to the patient, besides improved cosmesis, should be evaluated in future studies.