Experience with Modified Single-Port Laparoscopic Procedures in Children

Abstract

The aim of this study was to determine the safety and efficacy of limited-access laparoscopic procedures in children by using a modified single-port access (SPA) technique. A number of different basic laparoscopic procedures were attempted by using a modified 8-mm operating laparoscope with a 4-mm, 6-degree lens and an incorporated 5-mm operating channel. The operating scope was placed though an umbilical incision. The majority of cases also involved the use of a 3-mm instrument placed through a separate stab-wound incision or 3-mm port. Patient age ranged from 9 months to 16 years and weight from 7 to 60 kg. Procedures included laparoscopic cholecystectomy in 10, appendectomy in 8, enterolysis in 2, ovarian cystectomy in 1, and inguinal hernia repair in 15 patients. All procedures, except one, were successfully completed by using the SPA technique. A hernia repair in a 15-year-old male was converted to a three-port laparoscopic repair, because the operating scope could not adequately access the area. Operative times were longer than comparable procedures if using a standard laparoscopic approach, but a statistical analysis was not performed. There were no operative or postoperative complications. A modified SPA technique appears to be a safe, viable alternative to a standard laparoscopic approach for some procedures in children. The primary advantage is cosmetic. Visualization and tissue manipulation are more difficult and time consuming. The addition of a single 3-mm instrument at a separate site allows for easier dissection and triangulation, with almost no visible scarring. This may be more beneficial than creating a single 20-mm incision in the umbilicus with multiple ports, with nearly the same cosmetic result.