Abstract
ABSTRACTPurpose:To describe our experience utilizing Laparoendoscopic single site (LESS) surgery in pediatric urology.Materials and Methods:Retrospective chart review was performed on LESS urologic procedures from November 2009 through March 2013. A total of 44 patients underwent 54 procedures including: nephrectomy (23), orchiopexy (14), varicocelectomy (9), orchiectomy (2), urachal cyst excision (3), and antegrade continence enema (3) (ACE).Results:Median patient age was 6.9 years old. Estimated blood loss (EBL), ranged from less than 5cc to 47cc for a bilateral nephrectomy. Operative time varied from 56 mins for varicocelectomy to a median of 360 minutes for a bilateral nephroureterectomy. Incision length ranged between 2 and 2.5cm. In our initial experience we used a commercial port. However, as we progressed, we were able to perform the majority of our procedures via adjacent fascial punctures for instrumentation at the single incision site. One patient did require conversion to an open procedure as a result of bleeding. Three complications were noted (6.8%), with two Clavien Grade 3b complications. Two patients required additional procedures at 1-year follow-up.Conclusions:The use of LESS applies to many pediatric urologic procedures, ideally for ablative procedures or simple reconstructive efforts. The use of adjacent fascial puncture sites for instrumentation can obviate the need for a commercial port or multiple trocars.
Highlights
With the advent of minimal invasive surgery, urology has moved to the forefront in regards to innovation and instrumentation in its use compared to open surgery without jeopardizing functional outcomes
We report on our 3-year experience of Laparoendoscopic single site (LESS) in children who underwent a variety of urologic procedures utilizing this technique
The operative time varied based on the procedure performed, from 56 minutes for a varicocelectomy to an average of 345 minutes for a bilateral nephroureterectomy
Summary
With the advent of minimal invasive surgery, urology has moved to the forefront in regards to innovation and instrumentation in its use compared to open surgery without jeopardizing functional outcomes. With increasing experience in the laparoscopic environment, efforts are directed at further minimizing the number of incisions while maintaining the basics tenets of laparoscopic surgery [1]. There have ibju | Pediatric LESS in Urology been a variety of descriptions on the approach to LESS including the use of conventional versus articulating instruments as well as commercial ports [4]. This advancement and transformation to the pediatric population is starting to gain momentum as an option for surgical intervention with overall cosmesis as a surrogate outcome marker [5]. We report on our 3-year experience of LESS in children who underwent a variety of urologic procedures utilizing this technique
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