Division of Pediatric Surgery, University of Miami Miller School of Medicine, PO Box 016960, Miami, FL 33101, USA.
Surg Endosc. 2013 Apr;27(4):1367-71. doi: 10.1007/s00464-012-2617-5. Epub 2012 Dec 13.
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.
单切口腹腔镜手术（SILS）是一种新的微创领域，它使用一个单一的切口将所有的端口最小化到一个位置。最终的结果是切口可以在脐部进行战略性的放置，以达到无疤痕的腹部。作者认为，鉴于这种方法的快速普及，进行随机对照试验是很重要的。
一项机构审查委员会批准的前瞻性随机试验比较了在一家独立的儿童医院接受 SILS（SILS-A）和传统腹腔镜（LAP-A）阑尾切除术的患者，中位随访时间为 2.2 年。
共有 50 名患者（50%为男性，67%为西班牙裔）被平均随机分为 SILS-A 和 LAP-A 两组。这些患者的年龄在 3 至 15 岁之间，两组之间没有差异。其中一半（50%）的患者年龄小于 8 岁。SILS-A 的技术包括一个单一的脐上曲线皮肤切口和三个筋膜切口。插入端口的深度不同，以最小化器械运动的限制。同轴可视化通过使用 30°的内窥镜得到改善。为了实现与 LAP-A 的技术可比性，使用了吻合器设备，这需要将 5 毫米的端口扩大到 12 毫米的端口。手术的平均时间为 46.8 ± 3.7 分钟（范围，22-120 分钟），而标准 LAP-A 的平均时间为 34.8 ± 2.5 分钟（范围，18-77 分钟）（p = 0.010）。没有转换，两组在住院时间上没有差异。术后并发症包括 SILS-A 组有一例切口血清肿（无显著差异），无疝发生。两组在再入院率、饮食耐受性、发热或术后疼痛方面无差异。
尽管在年幼的儿童中腹部有限，但该研究结果表明 SILS 方法在儿科人群中是可行的。尽管 SILS 手术室时间目前长于 LAP-A，但它们是可比的，在住院期间或随访期间，两种技术的其他结果没有明显差异。
