Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
J Endourol. 2014 May;28(5):513-6. doi: 10.1089/end.2013.0125. Epub 2013 Dec 11.
Laparoscopy is a common approach to manage varicoceles in both the adult and pediatric population. The purpose of this study is to report our experience and compare outcomes between conventional laparoscopy and laparoendoscopic single-site (LESS) surgery for varicocelectomy in the pediatric population.
A retrospective cohort study was performed of all patients who underwent conventional laparoscopic varicocelectomy (LV) and laparoendoscopic single-site varicocelectomy (LESSV) at a single pediatric institution from December 2007 to March 2012. Patient demographics, intraoperative details, narcotic use, and complications were reviewed.
LV was performed in 32 patients and LESSV in 11 patients. None had conversion to open surgery. Median age was 16 years for LV (range 12-23) and 15 years for LESSV (range 12-20), P=0.061. Median operative time was 55 minutes for LV (range 28-90) and 46 minutes for LESSV (range 33-59), P=0.037. Nine (81.8%) patients in the LESSV group and 10 (31.2%) patients in the LV group were administered narcotics in the recovery room, P=0.005. One (3.1%) patient in the LV group was administered ketorolac in the recovery room, P=1. Five patients in each group, LESSV (45.5%) and LV (15.6%), received acetaminophen in the recovery room, P=0.092. All procedures were performed on an outpatient basis except for one because of a concomitant procedure. Median follow-up was 22 months in LV and 15 months in LESSV, P=0.015. One (3.1%) postoperative hydrocele was noted after LV and 1 (9.1%) after LESSV, P=0.451. All varicoceles were clinically resolved in both groups.
LESSV is comparable to LV in the pediatric population. Our initial experience indicates that the LESS approach may be more painful in the immediate postoperative period than conventional laparoscopy. The LESS technique warrants further evaluation to determine if one approach is clearly more advantageous.
腹腔镜检查是成人和儿科人群中治疗精索静脉曲张的常用方法。本研究的目的是报告我们的经验，并比较儿童人群中传统腹腔镜精索静脉结扎术（LV）和经腹腔镜单部位（LESS）手术治疗精索静脉曲张的结果。
对 2007 年 12 月至 2012 年 3 月在一家儿科单机构接受传统腹腔镜精索静脉结扎术（LV）和腹腔镜单部位精索静脉结扎术（LESSV）的所有患者进行了回顾性队列研究。回顾了患者的人口统计学资料、术中细节、麻醉药物使用和并发症情况。
LV 组 32 例，LESSV 组 11 例，均未转为开放手术。LV 组的中位年龄为 16 岁（范围 12-23），LESSV 组为 15 岁（范围 12-20），P=0.061。LV 组的中位手术时间为 55 分钟（范围 28-90），LESSV 组为 46 分钟（范围 33-59），P=0.037。LESSV 组 9 例（81.8%）患者和 LV 组 10 例（31.2%）患者在恢复室使用了麻醉药物，P=0.005。LV 组有 1 例（3.1%）患者在恢复室使用了酮咯酸，P=1。两组各有 5 例（LESSV 组 45.5%，LV 组 15.6%）患者在恢复室使用了对乙酰氨基酚，P=0.092。除 1 例因同时进行其他手术外，所有手术均在门诊进行。LV 组中位随访时间为 22 个月，LESSV 组为 15 个月，P=0.015。LV 组有 1 例（3.1%）发生术后阴囊积水，LESSV 组有 1 例（9.1%），P=0.451。两组精索静脉曲张均临床治愈。
LESSV 在儿科人群中与 LV 相当。我们的初步经验表明，与传统腹腔镜相比，LESS 术后早期可能更疼痛。LESS 技术需要进一步评估，以确定一种方法是否具有明显优势。
