Single-incision Laparoscopic Surgery Approach Research Articles

Transumbilical Stapling Technic of OAGB.

Single-port or single-incision laparoscopic surgery (SILS) is esteemed for its efficacy in achieving superior postoperative cosmetic outcomes compared to the conventional laparoscopic approach (Behnia-Willison et al. in Aust N Z J Obstet Gynaecol 52:366-370, 2012; Rogula et al. in Obes Surg 24:1102-1108, 2014; Pitot et al. in Surg Endosc 28:3007-3011, 2014). The introduction of SILS for bariatric procedures can be attributed to the pioneering work of Saber in 2008, who initially applied this technique to laparoscopic sleeve gastrectomy (SG), followed by its utilization in laparoscopic adjustable gastric banding (AGB) (Saber et al. in Obes Surg 18:1338-1342, 2008;Nguyen et al. in Obes Surg 18:1628-1631, 2008). The inaugural application of SILS in Roux-en-Y gastric bypass (RYGB) was documented in 2009, employing a plastic reconstruction methodology. Acknowledging the intricate nature of complex bariatric interventions, we previously detailed a modified SILS approach termed the transumbilical two-site (TUTS) technique for RYGB, which was established as a standard procedure in 2010 (Lee et al. in Surg Obes Relat Dis. 8:208-13, 2012). At that juncture, a solitary article surfaced in 2010 elucidating the dimensions of the small gastric pouch as a mere 8-9cm, falling short of contemporary surgical requisites for optimal outcomes in one anastomosis gastric bypass (OAGB) (Tacchino et al. in Obes Surg 20:1154-1160, 2010). Notably, the TUTS technique, which was successfully implemented for RYGB, had hitherto not been extended to OAGB due to the complexities associated with creating a slender gastric tube spanning 25cm. In a pioneering development this year, we have devised a novel strategy to surmount this challenge. The present study is designed to expound upon the transumbilical stapling technique tailored to the unique demands of OAGB.

A learning curve in using organ retractor for single-incision laparoscopic right colectomy

Single-incision laparoscopic surgery (SILS) has the potential to improve perioperative outcomes, including less postoperative pain, shorter operation time, less blood loss, and shorter hospital stay. However, SILS is technically difficult and needs a longer learning curve. Between April 2016 and September 2019, a total of 198 patients with clinical stage I/II right colon cancer underwent curative resection. In the case of the SILS approach, an organ retractor was usually used to overcome SILS-specific restrictions. The patients were divided into two groups by surgical approach: the SILS with organ retractor group (SILS-O, n = 33) and the conventional laparoscopic surgery group (LAC, n = 165). Clinical T status was significantly higher in the LAC group (p = 0.016). Operation time was shorter and blood loss was lower in the SILS-O group compared to the LAC group (117 vs. 197 min, p = 0.027; 10 vs. 25 mL, p = 0.024, respectively). In the SILS-O group, surgical outcomes including operation time, blood loss, number of retrieved lymph nodes, and postoperative complications were not significantly different between those performed by experts and by non-experts. Longer operation time (p = 0.041) was significantly associated with complications on univariate and multivariate analyses (odds ratio 2.514, 95%CI 1.047–6.035, p = 0.039). SILS-O was safe and feasible for right colon cancer. There is a potential to shorten the learning curve of SILS using an organ retractor.

Evolution and Standardisation of Techniques in Single-Incision Laparoscopic Bariatric Surgery.

Bariatric surgery has proven benefits for morbid obesity and its associated comorbidities. Laparoscopic approach is well established for bariatric surgery. Single-incision laparoscopic surgery (SILS) offers even more minimally invasive approach for the same with the added advantage of better cosmesis. We have developed and standardised the SILS approach at our institute. We share our experience and technical "tips" and modifications which we have learnt over the years. Technical details of performing sleeve gastrectomy and Roux-en-Y gastric bypass with special attention to liver retraction, techniques of dissection in difficult areas, creation of anastomoses and suturing have all been described. In our experience and in experience of others, single-incision bariatric surgery is feasible. Use of conventional laparoscopic instruments makes single-incision approach practical for day-to-day practice. Supervised training is essential to learn these techniques.

Single Incision Laparoscopic Surgery for Surgical Treatment of Tubal Ectopic Pregnancy: A Feasible Alternative to Conventional Laparoscopy

Abstract Objective: Laparoscopy is increasingly the preferred surgical approach in patients with ectopic pregnancy. The aim of this research was to evaluate the feasibility, safety, and outcomes of surgery for tubal ectopic pregnancy using single incision laparoscopic surgery (SILS) in comparison to conventional laparoscopic surgery (CLS) in the authors' local setting. Design: This single-center prospective study included consecutive patients treated by the SILS or CLS approach for salpingectomy in tubal ectopic pregnancy from September 1, 2011, to April 1, 2016. Materials and Methods: Information on patient bio-data, intra-, and postoperative data were collected and compared between patients who underwent the two surgical approaches. Results: In total, 93 consecutive patients underwent surgery for salpingectomy in tubal ectopic pregnancy. Of these, 33 (Group 1) were treated by SILS and 60 (Group 2) were treated by standard CLS. All 33 (100%) patients were treated successfully with the SILS approach, with...

Single-Incision Laparoscopic Surgery: Excision of Cornual Ectopic Pregnancy Made Simple Using ENDOLOOP

Abstract Background: Cornual or interstitial pregnancy is a rare subtype of ectopic pregnancy in which diagnosis may be elusive and treatment challenging. The laparoscopic approach has been used for treating this kind of pregnancy surgically whenever possible. However, reports on single-incision laparoscopic surgery (SILS) for treating cornual ectopic pregnancy are extremely sparse. This article describes a simplified SILS approach for treating a cornual ectopic pregnancy, using two ENDOLOOP® ligatures. With this technique, surgeons could find it easier to adopt SILS for treating cornual ectopic pregnancy. Case: A 27-year-old Chinese female presented with a spontaneous right cornual ectopic pregnancy of 8 weeks' gestation. She was in stable condition with a preoperative serum β–human chorionic gonadotropin (β-hCG) level of 16,673 IU/L. Single-incision laparoscopic excision of the pregnancy, using 2 ENDOLOOP ligatures, was performed. Her serial serum β-hCG levels were monitored. Results: The cornual ectopi...

Single-incision laparoscopic surgery increases the risk of unintentional thermal injury from the monopolar "Bovie" instrument in comparison with traditional laparoscopy.

Single-incision laparoscopic surgery (SILS) places multiple instruments in close, parallel proximity, an orientation that may have implications in the production of stray current from the monopolar "Bovie" instrument. The purpose of this study was to compare the energy transferred during SILS compared to traditional four-port laparoscopic surgery (TRD). In a laparoscopic simulator, instruments were inserted via SILS or TRD setup. The monopolar generator delivered energy to a laparoscopic L-hook instrument for 5-s activations on 30-Watts coag mode. The primary outcome (stray current) was quantified by measuring the heat of liver tissue held adjacent to the non-electrically active 10-mm telescope tip and Maryland grasper in both the SILS and TRD setups. To control for the potential confounder of stray energy coupling via wires outside the surgical field, the camera cord and active electrode wires were oriented parallel or completely separated. SILS and TRD setups create similar amounts of stray current as measured by increased tissue temperature at the non-electrically active telescope tip (41±12 vs. 39±10°C; p=0.71). Stray current was greater in SILS compared to TRD at the tip of the non-electrically active Maryland forceps (38±9 vs. 20±10°C; p<0.01). Separation of the active electrode and camera cords did not change the amount of stray energy in the SILS orientation for either telescope (39±10°C bundled vs. 36±10°C separated; p=0.40) or grasper (38±9°C bundled vs. 34±11°C separated; p=0.19) but did in the TRD orientation (41±12 bundled vs. 24±10 separated; p<0.01). When SILS was compared to TRD with the cords separated, SILS increased stray energy at both the telescope tip and grasper tip (36±10 vs. 24±10°C; p<0.01 and 34±11 vs. 17±8°C; p<0.01). SILS increases stray energy transfer nearly twice as much as TRD with the use of the monopolar instrument. Strategies to mitigate the amount of stray energy in the TRD setup such as separation of the active electrode and camera cords are not effective in the SILS setup. These practical findings should enhance surgeons using the SILS approach of increased stray energy that could result in injury.

Single Incision Laparoscopic Excision of Cornual Ectopic Pregnancy Made Simple Using Endoloop®

Abstract Background: Cornual or interstitial pregnancy is a rare subtype of ectopic pregnancy in which diagnosis may be elusive and treatment challenging. The laparoscopic approach has been used for treating this kind of pregnancy surgically whenever possible. However, reports on single-incision laparoscopic surgery (SILS) for treating cornual ectopic pregnancy are extremely sparse. This article describes a simplified SILS approach for treating a cornual ectopic pregnancy, using two ENDOLOOP® ligatures. With this technique, surgeons could find it easier to adopt SILS for treating cornual ectopic pregnancy. Case: A 27-year-old Chinese female presented with a spontaneous right cornual ectopic pregnancy of 8 weeks' gestation. She was in stable condition with a preoperative serum β–human chorionic gonadotropin (β-hCG) level of 16,673 IU/L. Single-incision laparoscopic excision of the pregnancy, using 2 ENDOLOOP ligatures, was performed. Her serial serum β-hCG levels were monitored. Results: The cornual ectopi...

Single-incision laparoscopic surgery in children: a randomized control trial of acute appendicitis

Single-incision laparoscopic surgery (SILS) is a novel area of minimally invasive surgery that uses a single incision to minimize all ports to one site. The end result is an incision that can be strategically placed in the umbilicus for a perceived scarless abdomen. The authors rationalized that a randomized controlled trial was important given the rapid popularization of this approach. An institutional review board-approved prospective randomized trial compared patients undergoing SILS (SILS-A) and conventional laparoscopic (LAP-A) appendectomy at a free-standing children's hospital during a median follow-up period of 2.2 years. A total of 50 patients (50 % boys and 67 % Hispanics) were randomized equally to SILS-A and LAP-A. The patients ranged in age from 3 to 15 years without a difference between the two groups. Half (50 %) of these patients were younger than 8 years. The technique for SILS-A involved a single supraumbilical curvilinear skin incision with three fascial incisions. Ports were inserted to varying depths to minimize restriction of instrument movement. Coaxial visualization was improved by the use of a 30° scope. To achieve technical comparability with the LAP-A, a stapler device was used, which required upsizing a 5 mm port to a 12 mm port. The mean duration of the operation was 46.8 ± 3.7 min (range, 22-120 min) compared with 34.8 ± 2.5 min (range, 18-77 min) for standard LAP-A (p = 0.010). No conversions occurred, and the two groups did not differ in hospital length of stay. The postoperative complications consisted of one wound seroma in the SILS-A group (nonsignificant difference), and no hernias were seen. No difference in readmissions, diet tolerance, fever, or postoperative pain was noted between the two groups. The findings show the SILS approach to be feasible in the pediatric population despite the limited abdominal domain in younger children. Although SILS operating room times currently are longer than for LAP-A, they are comparable, and no other outcomes differed appreciably between the two techniques at the time of hospitalization or during the follow-up period.

Single-Incision Laparoscopic Adjustable Gastric Banding is Effective and Safe: 756 Cases in an Academic Medical Center

Laparoscopic adjustable gastric banding (LAGB) is safe and effective. This less invasive option involving fewer incisions and umbilical approaches is coined as single-incision laparoscopic surgery (SILS). Over the last 3 years, we performed 46 % of our LAGBs as SILS with excellent results. This is a retrospective review of 1,644 LAGBs performed between 2008 and 2010. A total of 756 were performed as SILS bands (46 %) and 888 as standard (non-SILS) (54 %). Data points compared include operative time, percent of excess weight loss at 1 and 2 years, complication, and re-operation rates. Groups were matched by age, initial BMI, and gender: 584 non-SILS and 710 SILS patients. The average operating time was 44.3 ± 19.6 min for SILS and 51.1 ± 19.4 min for non-SILS (p < 0.001). The 12-month percent excess weight loss (%EWL) for SILS was 45.0 ± 19.1; it was 40.7 ± 17.5 for non-SILS (p = 0.003). The 24 month %EWL for SILS was 54.4 ± 16.3; it was 46.4 ± 16.1 for non-SILS (p = 0.10). Complication rates were 5.6 % (40 of 710) for SILS and 4.5 % (26 of 584) for non-SILS (p = 0.34). The 30-day readmission/re-operation rates are 1 % (seven of 710) for SILS and 1.5 % (nine of 584) for non-SILS (p = 0.37). There was one death in the SILS group. We have been performing more SILS bands over time. Our operative times and weight loss figures show that it is an efficient and effective means of weight loss. Furthermore, the data also show that the SILS approach is safe and does not increase operative time. In conclusion, SILS laparoscopic adjustable gastric banding is a safe and effective means of attaining weight loss in selected patients.

Single‐incision laparoscopic surgery for small bowel resection with an intraumbilical arcuate incision in children

Single-incision laparoscopic surgery (SILS) has been performed on children for various procedures. However, few reports are available about SILS for small bowel resection, particularly involving conventional instruments in the pediatric population. Herein, we report four cases of small bowel resection with single umbilical incision and a three-trocar approach. From October 2010 to September 2011, we performed small bowel resection with SILS on four cases, including a boy with an intestinal duplication cyst and three children with Meckel's diverticulum. An intraumbilical arcuate incision was made to expose the abdominal wall fascia, and one 5-mm and two 3.5-mm trocars were inserted. It was not necessary to extend the initial incision to exteriorize the lesion except in one case in which we applied the so-called Y-V closure plasty. All procedures were successful and did not require conversion, and all patients recovered smoothly without any complications. Small bowel resection using the SILS approach is suitable for these diseases.

Single-incision Laparoscopic Cholecystectomy Learning Curve Experience Seen in a Single Institution

Single-incision laparoscopic surgery (SILS) is laparoscopic surgery done by one incision through the umbilicus. Cholecystectomy lends itself well to a SILS approach. As these procedures have become more widely adapted, it is important to determine the approximate learning curve to decrease two surgical endpoints: (1) time to completion of the procedure; and (2) decreased incidence of conversion. We prospectively reviewed our series of 50 cholecystectomies done using the SILS approach between May 2008 to September 2008. All cases were performed by two advanced laparoscopic surgeons at a single institution. Data was collected immediately after the case and entered into an Excel database. Cases were performed by insufflating the abdomen with a Veress needle through the umbilicus followed by placement of 5-mm ports at the umbilicus. Patient ages ranged between 21 and 82 years with a median age of 45 years. Body mass index (BMI) range was 21 to 42 kg/m with a mean of 30 kg/m. Average length of time for cases was 1 hour 9 minutes with a range between 55 minutes and 120 minutes. The average length of time for the first 25 cases was 80 minutes. When compared with cases 26 to 50 the average length of time was 60 minutes (P<0.05). The conversion rate to conventional laparoscopic cholecystectomy was 10%. Conversion was accomplished through the addition of a 5-mm port elsewhere on the abdominal cavity. After the tenth case, the incidence of conversion went down to zero. When conversions were further stratified, they occurred within each individual surgeon's first ten cases. The learning curve for successful consistent completion of SILS cholecystectomy cases appears to be after 25 cases. In addition, conversion rates drop dramatically after the first ten cases.

Single-incision laparoscopic transabdominal preperitoneal herniorrhaphy for recurrent inguinal hernias: preliminary surgical results

Since the early 1990s, laparoscopy has provided surgeons with new and innovative ways to treat various surgical problems. Many of these minimally invasive techniques have gained universal acceptance by demonstrating improved patient outcomes. Single-incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of traditional laparoscopy. Laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy via the three-trocar technique is widely used for recurrent inguinal hernia. To the author's knowledge, this report describes first series of SILS TAPP for recurrent inguinal hernia repair. From April 2009 to March 2010, 15 single-incision laparoscopic TAPP repairs of recurrent inguinal hernia were performed by the same surgical team. The data collected prospectively included patient demographics, type of hernia, operative time, complications, postoperative hospital stay, and recurrence. The umbilicus was the sole point of entry for all patients using a single port, and the same operative technique was used in all cases. The SILS TAPP procedure was performed successfully for all the patients, and none required conversion to an open procedure or a conventional laparoscopic hernia repair by the addition of more entry ports. The mean operative time was 51 ± 17 min. No intra- or postoperative complications were recorded. There was no evidence of early recurrence during a mean follow-up period of 130 ± 77 days. Based on this experience, the author believes that SILS approach is technically feasible and safe using standard and slightly modified instruments for standard TAPP. The cosmetic benefit is clear, but the advantages of SILS TAPP over conventional laparoscopic surgery during long-term follow-up evaluation will require further randomized clinical trials.

Veress Needle: A Simple Liver Retraction Technique for Lap Band Positioning in (Single Incision Laparoscopic Technique) SILS

To the Editor:Sir,We read with interest the recent articles of Nguyen et al. [ 1]and of Reavis et al. [ 2] reporting their experience withadjustable gastric banding and sleeve gastrectomy, respec-tively, utilizing a novel minimally invasive surgical approach:single incision laparoscopic surgery (SILS).Recent publications confirm the rapid increase in the useof SILS, not only for bariatric surgery but for a wide rangeof routine laparoscopic procedures [3–10]. In most of thepublished reports, it is argued that SILS has the potentialadvantage of reduced post-operative pain and port-sitecomplications, as well as being virtually ‘scarless’. Optimalcosmetic outcomes would seem to be especially relevant topatientsundergoinggastricbanding,whoareoftendisappoint-ed with the degree of post-operative scarring. The standardapproach to band implantation typically requires a 3- to 4-cmincision for the access port site, together with three to foursmaller (5–10 mm) trocar incisions. Where technicallyfeasible, therefore, a SILS approach would appear to be anattractive alternative.A key problem in the application of SILS to gastricbanding (and other gastric surgeries) is how to achieveadequate retraction of the liver, without resorting to thestandard trocar placement.Huang et al., in order to retract left liver lobe for aSILS procedure of a gastric bypass, proposed a systemconsisting of a Jackson–Pratt drainage penetrated with a2-0 Prolene and fixed with Kelly clamps at the skin [11].As the author confirmed, mean time to carry out thisprocedure is 5 min.Hamzaoglu et al. [12], in order to carry out a singleincision Nissen fundoplication and considering a left liverretraction system of Sakaguchi et al’s lap gastrectomy [13],adopted a Penrose drain of 8 cm long and 1 cm large tiedwith two silk sutures of 10 cm in length and fixed at theskin externally. Also, in this case, the procedure isconsidered fixed and carried out for 5–7 min.Tanigawa [14] as well proposed, for a laparoscopicesophagogastric procedure, a 17-cm-long and 6-mm-largehand-made Penrose drain fixed with three heavy ties alongits length at the peritoneum.More recently, Ganta [15] proposed the ‘Ganta stitch’ forleft lobe liver retraction in single incision LapBand. Itconsists of a 2-0 Ethibond suture placed from the crura of

Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax using a single-incision laparoscopic surgery port: a feasible and safe procedure

Recent authors have pioneered the use of single-incision laparoscopic surgery (SILS) for umbilical cholecystectomy. The SILS approach has the potential of reducing the trauma of the surgical access and postoperative pain. Video-assisted thoracic surgery (VATS) greatly reduces patient postoperative pain compared with traditional thoracotomy incisions. The current trend is to use fewer working ports to reduce even more postoperative pain, chest wall paresthesia, and hospital stay. No reports have described using a SILS port in VATS. From September 2009 to March 2010, 13 patients had surgery for primary spontaneous pneumothorax. The patients underwent single-lung ventilation. A 2.5-cm-long incision was made at the sixth intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a single flexible port. A 5-mm 0° videothoracoscope, a roticulating grasper, and an endoGIA stapler were introduced through port channels. Apical lung blebs were stapled, and pleurodesis by pleural abrasion with Marlex mesh was performed. The study enrolled nine men (69.2%) and four women with a median age of 26.3years. No complications were recorded. The postoperative pain was mild for 10 patients (76.9%) and moderate for 3 patients. Mild chest wall paresthesia (numbness) was observed in three patients (23.07%). The postoperative hospital stay was 2.15days. Although the SILS port is for laparoscopic use, it allowed an adequate lineup of the instruments along the intercostal space and adequate instrument maneuverability for stapling and resecting of apical lung bullae or blebs. The procedure was accomplished successfully for 92.3% of the patients. This is the first report on the use of a SILS port in VATS. Further work and development of a proper thoracic single port are needed to define the uses and advantages of this uniportal technique.

Single-incision Laparoscopic Nephrectomy and Heminephroureterectomy in Young Children Using Conventional Instruments: First Report of Initial Experience

To report the surgical technique and the early outcomes of nephrectomy and heminephroureterectomy by single-incision laparoscopic surgery (SILS) in children using conventional laparoscopic instruments only. Three consecutive children (aged 3, 4 and 7 years) who underwent nephrectomy for multicystic dysplastic kidney (n = 2) and upper moiety heminephroureterectomy for duplex kidney (n = 1) by SILS were retrospectively reviewed. A standardized infraumbilical incision was used for the insertion of 3 reusable ports of 3 and 5 mm. The SILS procedure was performed by the technique of crossing 2 straight instruments. All 3 procedures were successfully performed by SILS without any intraoperative complications or need for conversion. The 2 nephrectomies were each completed in 120 minutes, whereas the heminephroureterectomy took 400 minutes. Only 1 dose of narcotic analgesic was required by 1 patient, and 2-6 doses of oral acetaminophen were taken for postoperative pain control. All 3 children recovered smoothly from surgery without complications. Nephrectomy and heminephroureterectomy by SILS using conventional instruments are technically feasible in young children. Further studies are required to investigate whether the SILS approach can become a sound alternative to standard laparoscopy.

Single-incision laparoscopic right colectomy for cancer: a single-centre preliminary experience

The rationale for single-incision laparoscopic surgery (SILS) is minimizing morbidity, as well as improving cosmetic results of laparoscopic approach. This technique has been used for a variety of procedures and has recently been proposed for colonic resections as well. We report our preliminary experience of right colectomy, performed through a SILS approach. Five patients (3 males, 2 females, mean age 81.6 years) were selected to undergo SILS right colectomy for cancer. The procedure was carried out through a SILS multi-port device (SILS™ Port, Covidien Ltd, Norwalk, CT, USA), with either conventional or specially designed instruments. A medial-to-lateral approach and an extra-corporeal anastomosis were performed. In three cases, the procedure was completed through the SILS technique; in two of these cases a combined procedure was carried out (right colectomy plus cholecystectomy, right colectomy plus cholecystectomy plus i.o. colonoscopy and polypectomy). In one case, a switch to standard laparoscopy was necessary because of the large dimension of the tumour, while in the other case an intolerance of pneumoperitoneum was registered, thus requiring a conversion to open surgery. SILS procedures proved to be oncologically correct. No major complications occurred. In selected patients, SILS right colectomy for cancer appears to be feasible and oncologically safe. Beyond the cosmetic advantage, the procedure may reduce postoperative morbidity. Further studies are needed, with larger series and a longer follow-up, to determine the incidence of possible long-term complications and to evaluate possible cost-effectiveness of the procedure.

A novel application for single-incision laparoscopic surgery (SILS): SIL jejunostomy feeding tube placement

Single-incision laparoscopic surgery (SILS) is rapidly gaining popularity as the practical alternative to natural orifice transluminal endoscopic surgery (NOTES). Although SILS achieves essentially the same goal as NOTES (a nearly invisible scar in the umbilicus), it does not carry the significant potential risks of a transluminal approach. The SILS approach has been most commonly described for cholecystectomy and appendectomy. The authors describe a novel application for this approach in the placement of a feeding jejunostomy tube. The described application for this technique is the first to be reported. The authors describe use of the technique for two intensive care unit (ICU) patients requiring long-term postpyloric tube feeds. Access was obtained through the umbilicus with the SILS port. The selected loop of the jejunum was exteriorized through this incision, and the feeding tube was placed. The loop was returned into the abdomen, and the SILS port was replaced in the incision. Under laparoscopic visualization and guidance, the feeding tube was brought externally through a predetermined site in the left midabdomen. Two patients underwent SILS jejunostomy tube placement. The average operating time was 42.5 min. No intraoperative or immediate postoperative complications occurred. Tube feedings were started on postoperative day 1 for both patients, with good bowel function. The SILS technique for jejunostomy placement is a promising and feasible alternative to the current methods. It is less invasive than the open approach while providing complete intraabdominal visualization. It is less technically demanding than the direct percutaneous endoscopic jejunostomy (PEJ) approach and avoids the risks and difficulties associated with it. The same benefits of other SILS procedures are evident in this application. The authors believe a series study will further highlight long-term benefits and any potential complications.

Single-incision laparoscopic surgery: feasibility for pediatric appendectomies

Introduction Single-incision laparoscopic surgery (SILS) is a novel area of minimally invasive surgery using a single incision. The end result is a lone incision at the umbilicus for a perceived scarless abdomen. We report our early experience using the SILS technique for appendectomies in the pediatric population. Methods A retrospective chart review was performed on our first patients to undergo SILS appendectomy (SILS-A) or laparoscopic appendectomy (LAP-A) during the same period at a freestanding children's hospital. Results Thirty-nine patients were reviewed. Nineteen patients underwent SILS-A (8.7 ± 0.76 [SEM] years old), and 20 patients underwent LAP-A (10.5 ± 0.87 years old, 2-17). Ages were 19 months to 14 years in the SILS-A group, with 21% (4 patients) not older than 6 years. Median weight for SILS-A was 32 kg (14.5-80.3). Twelve patients had acute nonperforated appendicitis (62%). Mean duration of operation was 58 ± 5.6 (30-135) minutes vs 43 ± 3.6 (30-85) minutes for standard LAP-A. Two patients were converted to a transumbilical appendectomy, one for inability to maintain a pneumoperitoneum and one for extensive adhesions. Postoperative complications consisted of one wound seroma. No wound infections, hernias, readmissions, or difference in length of stay were noted. Conclusion The SILS approach for acute appendicitis is feasible in the pediatric population even in patients as young as 19 months. Operating room times are somewhat longer than with LAP-A, but should decrease with improved instrumentation and experience. Larger studies and further technical refinements are needed before its widespread implementation.

Single-Incision Transumbilical Laparoscopic Splenic Cyst Unroofing: First Reported Case

Single-incision laparoscopic surgery is an emerging minimally invasive approach. When using the single-incision laparoscopic surgery approach, the surgeon operates almost exclusively through a single point of entry, usually the patient's umbilicus. This approach is steadily gaining popularity among minimally invasive surgeons, as it combines the cosmetic advantage of Natural Orifice Translumenal Surgery with the technical familiarity of conventional laparoscopic surgery. In this report, we describe our implementation of the single-incision laparoscopic approach to perform an unroofing of a posttraumatic splenic cyst; in this case, the entire procedure is performed through a 2-cm intraumbilical incision.