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.
Key words
laparoscopy - flexible-tip - single port surgery - paediatric - appendicectomy
