Optically guided peritoneal access in pediatric laparoscopy: is it a good alternative for open access? A prospective comparative study

Abstract

Background A minimally invasive approach has become the method of choice for treating many surgical cases. The superiority of open peritoneal access is owing to the low probability of visceral injury. Optically guided trocars were designed to decrease the injury risk to intra-abdominal contents by permitting the surgeon to see abdominal wall layers while traversing it and abdominal contents once access is complete. Materials and methods A prospective comparative study was done between optical trocar access using Fengh optical port, trocar model FLTC5 (Fengh medical Co. Ltd, Jiangsu, China), and open access using Hasson technique in pediatric patients. The study included 187 patients from the age of 1 year to the age of 16 years. Patients with previous open abdominal surgery, abdominal masses in the periumbilical region, and/or traumatic abdominal injury were excluded from the study. Access time and initial port insertion complications were reported to clarify safety and time for optical access. Results Optical access was done in 92 patients and open access in 95 patients. No visceral or major vascular complications were reported in both types of access. Access time in group IA (optical) was 58.06±16.1 s. in comparison with 175.7±54.7 s. in group IB (open) (P=0.0001*), and it was 49.7±9.4 s. in group IIA (optical) in comparison with 169.3±38.3 s. in group IIB (open) (P=0.0001*). Conclusions In selected cases, optical access is feasible, safe, and time-saving and avoids many problems in initial port insertion in pediatric laparoscopy.