Eur J Pediatr Surg 2011; 21(05): 322-324
DOI: 10.1055/s-0031-1283163
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Flexible-Tip Laparo-Endoscopic Surgery: A Bridge to Single Port Appendicectomy in Children

A. Zani
,
N. Ade-Ajayi
Further Information

Publication History

received09 May 2011

accepted after revision 13 June 2011

Publication Date:
21 October 2011 (online)

Abstract

Introduction:

Single port surgery (SPS) has been demonstrated to have some advantages over conventional laparoscopy. However, currently available port sizes may limit the application in younger children or those with a small umbilicus. Moreover, the consultant learning curve required to master single port surgery may have a negative impact on surgical training. We report the first series of children who were treated with a reduced incision technique for appendicectomy using flexible-tip laparo-endoscopic surgery (FLES).

Patients and Methods:

FLES was set up using one 11-mm and 2×5-mm bladeless ports (Ethicon XCEL™) via umbilical and low left iliac fossa incisions. A 10-mm flexible-tip laparo-endoscope was utilized. Tip angulation ensured visibility while minimising instrument clashing. A database of children undergoing FLES was kept prospectively. Demographic and peri-operative information and complications were recorded. Data are presented as medians with ranges.

Results:

Between March and June 2010, 5 children (4 females) aged 9 (4–13) years underwent FLES for right iliac fossa pain. 2 procedures were performed by the admitting consultant, 3 by a supervised inexperienced laparoscopic trainee. 4 children had acute appendicitis including 1 with an inflammatory mass. Another had a haemorrhagic ovarian cyst. Appendicectomy was performed in all. The duration of surgery was 104 (93–130) min, and postoperative hospital stay was 2 (1–6) days. At 7 (5–8) months’ follow-up no complications have been recorded. At follow-up, the cosmetic results were judged to be excellent in all by the children, their parents and the reviewing surgeon.

Conclusions:

FLES is an alternative to standard laparoscopy and SPS in children, and be performed effectively and safely by junior trainees. Cosmetic results are excellent. It may represent a bridge technology, particularly for younger children, until single port products and techniques more suitable for appendicectomy in this age group are available. Finally, flexible-tip technology may play a useful role as SPS evolves.

 
  • References

  • 1 Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2010; 10 CD001546
  • 2 Garey CL, Laituri CA, Ostlie DJ et al. A review of single site minimally invasive surgery in infants and children. Pediatr Surg Int 2010; 26: 451-456
  • 3 Oltmann SC, Garcia NM, Ventura B et al. Single-incision laparoscopic surgery: feasibility for pediatric appendectomies. J Pediatr Surg 2010; 45: 1208-1212
  • 4 Agarwal BB. Umbilicus, navel, belly button – Vitruvian guide for esthetic cosmetics: a Da Vinci code for beautiful informed consent. Surg Endosc 2010; 24: 236-238
  • 5 Perrone JM, Ames CD, Yan Y et al. Evaluation of surgical performance with standard rigid and flexible-tip laparoscopes. Surg Endosc 2005; 19: 1325-1328
  • 6 Weibl P, Klingler HC, Klatte T et al. Current limitations and perspectives in single port surgery: Pros and cons laparo-endoscopic single-site surgery (LESS) for renal surgery. Diagn Ther Endosc 2010; 2010 759431
  • 7 Phillips H, Fleet Z, Bowman K. The European Working Time Directive – interim report and guidance from The Royal College of Surgeons of England Working Party chaired by Mr. Hugh Phillips. London: Royal College of Surgeons; January 2003.
  • 8 Chalmers CR, Joshi S, Bentley PG et al. The lost generation. Impact of the 56-hour EWTD on current surgical training. Ann R Coll Surg Engl (Suppl) 2010; 92: 102-106
  • 9 Skidmore FD. Junior surgeons are becoming deskilled as result of Calman proposals. BMJ 1997; 314: 1281
  • 10 Ross DG, Harris CA, Jones DJ. A comparison of operative experience for basic surgical trainee in 1992 and 2000. Br J Surg. 2002 89. 60
  • 11 Nataraja RM, Ade-Ajayi N, Curry JI. Surgical skills training in the laparoscopic era: the use of a helping hand. Pediatr Surg Int 2006; 22: 1015-1020
  • 12 Brown CT, Kooiman G, Sharma DM et al. Scarless single-port laparoscopic pelvic kidney nephrectomy. J Laparoendosc Adv Surg Tech A 2010; 20: 743-746