de Armas Ismael A Salas, Garcia Isabella, Pimpalwar Ashwin
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, 6621 Houston, TX 77030, USA.
Pediatr Surg Int. 2011 Sep;27(9):985-9. doi: 10.1007/s00383-011-2892-6. Epub 2011 Apr 3.
Laparoscopy has become the gold standard technique for appendectomy and cholecystectomy. With the emergence of newer laparoscopic instruments which are roticulating and provide 7 degrees of freedom it is now possible to perform these operations through a single umbilical incision rather than the standard 3-4 incisions and thus lead to more desirable cosmetic results and less postoperative pain. The newer reticulating telescopes provide excellent exposure of the operating field and allow the operations to proceed routinely. Recently, ports [Triports (Olympus surgery)/SILS ports] especially designed for single incision laparoscopic surgery (SILS) have been developed. We herein describe our experience with laparoscopic single port appendectomies and cholecystectomies in children using the Triport. This is a retrospective cohort study of children who underwent single incision laparoscopic surgery between May 2009 and August 2010 at Texas Children's Hospital and Ben Taub General Hospital in Houston Texas by a single surgeon. Charts were reviewed for demographics, type of procedure, operative time, early or late complications, outcome and cosmetic results. Fifty-four patients underwent SILS. A total of 50 appendectomies (early or perforated) and 4 cholecystectomies were performed using this new minimally invasive approach. The average operative time for SILS/LESS appendectomy was 54 min with a range between 25 and 205 min, while operative time for SILS cholecystectomy was 156 min with a range of 75-196 min. Only small percentage (4%) of appendectomies (mostly complicated) were converted to standard laparoscopy, but none were converted to open procedure. All patients were followed up in the clinic after 3-4 weeks. No complications were noted and all patients had excellent cosmetic results. Parents were extremely satisfied with the cosmetic results. SILS/LESS is a safe, minimally invasive approach for appendectomy and cholecystectomy in children. This new approach is performed in an acceptable operative time with good outcomes and great cosmetic result.
腹腔镜检查已成为阑尾切除术和胆囊切除术的金标准技术。随着新型可旋转且具有7个自由度的腹腔镜器械的出现，现在可以通过单一脐部切口而非标准的3 - 4个切口来进行这些手术，从而获得更理想的美容效果和更少的术后疼痛。新型可旋转腹腔镜提供了极佳的手术视野暴露，并使手术能够常规进行。最近，专门为单切口腹腔镜手术（SILS）设计的端口[Triports（奥林巴斯手术器械）/SILS端口]已被开发出来。我们在此描述我们使用Triport对儿童进行腹腔镜单端口阑尾切除术和胆囊切除术的经验。这是一项回顾性队列研究，研究对象为2009年5月至2010年8月在德克萨斯州休斯顿的德克萨斯儿童医院和本·陶布综合医院由一名外科医生进行单切口腹腔镜手术的儿童。查阅病历以获取人口统计学信息、手术类型、手术时间、早期或晚期并发症、结局及美容效果。54例患者接受了SILS手术。使用这种新的微创方法共进行了50例阑尾切除术（早期或穿孔性）和4例胆囊切除术。SILS/LESS阑尾切除术的平均手术时间为54分钟，范围在25至205分钟之间，而SILS胆囊切除术的手术时间为156分钟，范围在75至196分钟之间。只有一小部分（4%）阑尾切除术（大多为复杂病例）转为标准腹腔镜手术，但无一例转为开放手术。所有患者在术后3 - 4周在门诊进行随访。未发现并发症，所有患者均获得了极佳的美容效果。家长对美容效果极为满意。SILS/LESS是儿童阑尾切除术和胆囊切除术的一种安全、微创的方法。这种新方法在可接受的手术时间内完成，效果良好且美容效果极佳。
