A Semicircular Incision in the Superior Umbilical Fold for SILS Preserves the Umbilical Profile

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Abstract

Background. Single Incision Laparoscopic Surgery (SILS) has been highlighted in the recent literature as a means of performing a range of common, minimal access, paediatric surgical procedures. The primary attraction is the absence of visible scarring. Aim. This study aims to describe a cosmetically advantageous means of SILS port placement in children, which preserves the umbilical profile. Methods. We describe a paediatric case series utilising a semicircular incision in the superior umbilical fold for SILS procedures. The linea alba is exposed over 2 cm just superior to the umbilical ring and stay sutures are applied. A vertical incision is made over this distance without entering the umbilical ring. Data were recorded prospectively in a Microsoft Excel database. Results. Twenty-one cases were performed in a 1-year period. Ten appendicectomies, 5 ovarian/paraovarian cystectomies, 2 Palomo procedures, 3 nephrectomy/heminephrectomies, and 1 Meckel's diverticulectomy were performed. There was 1 wound infection. No incisional hernias occurred. Discussion. We believe that our technique, which maintains the integrity of the umbilical ring and allows preservation of the umbilical profile, offers a distinct cosmetic advantage over other incisions for SILS which distort it. Conclusion. We have demonstrated the aesthetic benefits of utilising a superior umbilical-fold incision for SILS in children.

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Most cited references 7

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Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations.

Sanjeev Dutta (2009)

Single incision laproscopic surgery (SILS) involves performing abdominal operations with laparoscopic instruments placed through a single, small umbilical incision. The primary goal is to avoid visible scarring. This is the first report of SILS cholecystectomy in children and the first report in the literature of SILS splenectomy. A retrospective chart review was performed in 20 consecutive inpatient SILS procedures (13 males, 7 females; ages 2-17 years) from May to December 2008. Outcome measures included need for conversion, operative time, time to oral analgesia, length of hospitalization, cosmetic outcome, and complications. There were 4 total splenectomies, 3 cholecystectomies, 2 combined splenectomy/cholecystectomies, and 11 appendectomies performed. All procedures were completed successfully without need for conversion to standard laparoscopy or open surgery. Mean operative time was 90 minutes for splenectomy, 68 minutes for cholecystectomy, 165 minutes for combined splenectomy/cholecystectomy, and 33 minutes for appendectomy. Mean hospital stay was 1 day for appendectomy, 1 day for cholecystectomy, and 2.5 days for splenectomy. One splenectomy patient received 1 U packed red blood cell transfusion. All appendectomy patients were converted to oral analgesia within 24 hours and splenectomy patients within 48 hours. All families were very pleased with the cosmetic outcome. Single incision laparoscopic surgery is feasible for a variety of pediatric general surgical conditions, allowing for scarless abdominal operations. This early experience suggests that outcomes are comparable to standard laparoscopic surgery but with improved cosmesis, however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain or recovery. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempting the various procedures. Technological refinements will further enable SILS.

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Appendectomy using single-incision pediatric endosurgery for acute and perforated appendicitis.

Oliver J. Muensterer, Norsarahaida Amin, Maxwell Adibe … (2010)

Single-incision pediatric endosurgical (SIPES) appendectomy has been reported in few pediatric surgical centers. We have adopted the technique recently and have offered it to all patients in whom appendectomy was indicated. The purpose of this study was to report our experience with SIPES appendectomy for acute appendicitis, perforated appendicitis, and interval appendectomy, and to compare the results with those from patients who underwent conventional laparoscopic appendectomy 1 year previously. After IRB approval, data on all SIPES appendectomies performed in our hospital were prospectively collected, including operative time, intra- and postoperative complications, conversion rate, blood loss, and hospital length of stay. Cases were stratified into three categories: acute appendicitis, perforated appendicitis, and interval appendectomy. They were compared to patients operated on in 2007 using conventional laparoscopic (three-trocar) appendectomy. During the study period, 75 SIPES appendectomies were undertaken. Mean age was 11 years (range = 2-19 years) and mean weight was 45 kg (range = 12-132 kg). All SIPES appendectomies were completed laparoscopically, and additional trocars were placed in 20% of cases. SIPES interval appendectomies took the longest and had the highest conversion rate (33%). Follow-up data was available in 63 patients (82%) at a median of 3 weeks. There were three wound infections in the SIPES group (4%) and one in the 151 control patients. Compared to historic controls, operative time was shorter with SIPES compared to conventional laparoscopy for acute appendicitis (37 ± 12.3 vs. 44.1 ± 20.3 min, p = 0.01, 95% CI = 32-42 min). SIPES appendectomy is a very good alternative to the conventional laparoscopic approach, especially for acute appendicitis. It is technically more challenging for perforated appendicitis and interval appendectomy. Yet, with appropriate consideration and skill, scarless appendectomy is achievable.

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Single-incision pediatric endosurgery: lessons learned from our first 224 laparoendoscopic single-site procedures in children.

Celia N. Hansen, K Georgeson, David Harmon … (2011)

To identify technical difficulties during single-incision pediatric endoscopic surgery (SIPES) cases and to highlight solutions. After IRB approval, all SIPES cases were prospectively collected, and the surgeons involved were polled for technical difficulties encountered and their operative solutions. Over a period of 13 months, 224 pediatric SIPES cases were performed in 223 pediatric patients (92 female, 131 male) aged 3 weeks to 19 years. Among these were 130 appendectomies, 32 pyloromyotomies, 32 cholecystectomies, 11 inguinal hernia repairs, 6 Nissen fundoplications and 4 laparoscopic-assisted endorectal pullthrough procedures. Eighteen procedures (8%) employed a primary extra-umbilical instrument in addition to the transumbilical trocar(s). Thirty procedures (13%) begun via a single-site technique required additional trocars for completion. None required laparotomy. Intraoperative complications are discussed. The main challenges of SIPES are: (1) variable umbilical anatomy, (2) large size of current proprietary multitrocar devices, (3) trocar crowding, (4) intra-abdominal exposure, (5) fewer degrees of freedom, (6) clashing instruments, (7) in-line endoscope viewing, and (8) limited number of working ports. We discuss coping strategies to address these issues. Many of the drawbacks of SIPES can be overcome by specific techniques, which can make SIPES procedures more broadly feasible and applicable within pediatric endosurgery.

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Author and article information

Journal

Journal ID (nlm-ta): Minim Invasive Surg

Journal ID (iso-abbrev): Minim Invasive Surg

Journal ID (publisher-id): MIS

Title: Minimally Invasive Surgery

Publisher: Hindawi Publishing Corporation

ISSN (Print): 2090-1445

ISSN (Electronic): 2090-1453

Publication date (Print): 2012

Publication date (Electronic): 12 December 2012

Volume: 2012

Electronic Location Identifier: 412623

Affiliations

Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Eastern Road, Brighton BN2 5BE, UK

Author notes

*A. A. Mahomed: anies.mahomed@ 123456bsuh.nhs.uk

Academic Editor: Othmar Schöb

Article

DOI: 10.1155/2012/412623

PMC ID: 3530783

PubMed ID: 23304486

SO-VID: 896754da-8272-452f-9a49-864db7868746

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 26 April 2012

Date revision received : 26 October 2012

Date accepted : 3 November 2012

A Semicircular Incision in the Superior Umbilical Fold for SILS Preserves the Umbilical Profile

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25th European Students' Conference

Most cited references 7

Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations.

Appendectomy using single-incision pediatric endosurgery for acute and perforated appendicitis.

Single-incision pediatric endosurgery: lessons learned from our first 224 laparoendoscopic single-site procedures in children.

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