Seims Aaron D, Russell Robert T, Beierle Elizabeth A, Chen Mike K, Anderson Scott A, Martin Colin A, Harmon Carroll M
Department of Pediatric Surgery, Children's of Alabama, 1600 7th Avenue South, Lowder Building Suite 300, Birmingham, AL, 35233, USA.
Surg Endosc. 2015 Jan;29(1):30-3. doi: 10.1007/s00464-014-3648-x. Epub 2014 Jul 2.
As proficiency with single-incision pediatric endosurgery (SIPES) increases, more challenging operations are being performed. While the ultimate goal is safe surgery, it may be beneficial to know what anatomical and technical factors contribute to the need for additional ports. This aspect of SIPES splenectomy has yet to be evaluated. The study objective was to identify these factors, potentially allowing surgeons to gauge appropriateness for single incision and to tailor techniques for optimal results.
This was an institutional review board-approved retrospective analysis of prospectively collected data (FWA00005960). SIPES splenectomies performed at a tertiary children's hospital since March of 2009 were included. Demographic and technical factors pertaining to each operation were available in our SIPES database. Fischer's exact and Wilcoxon rank sum tests were used to analyze categorical and continuous variables, respectively.
Thirty-seven patients 18 years of age and younger underwent attempted SIPES splenectomy. Two operations were converted directly to open and were excluded from analysis. Of the remaining 35 operations, 15 (42.9 %) were completed with additional ports. Gender, age, body mass index, splenic weight, indication for operation and the presence of accessory spleens did not contribute to the need for added ports. The only factor to reach statistical significance was the number of channels present in the SIPES access device (p = 0.002).
Completion of SIPES splenectomy was associated with the decision to utilize an access device with four channels. Anatomic variables did not appear to affect the ability to complete SIPES splenectomy.
随着单切口小儿内镜手术（SIPES）技术的日益成熟，越来越多具有挑战性的手术得以开展。虽然最终目标是实现安全手术，但了解哪些解剖和技术因素导致需要额外增加切口可能会有所帮助。SIPES脾切除术的这一方面尚未得到评估。本研究的目的是确定这些因素，从而可能使外科医生能够评估单切口手术的适宜性，并调整技术以获得最佳效果。
这是一项经机构审查委员会批准的对前瞻性收集数据的回顾性分析（FWA00005960）。纳入了自2009年3月起在一家三级儿童医院进行的SIPES脾切除术。我们的SIPES数据库中提供了与每次手术相关的人口统计学和技术因素。分别使用费舍尔精确检验和威尔科克森秩和检验来分析分类变量和连续变量。
37例18岁及以下的患者尝试进行SIPES脾切除术。其中2例手术直接转为开放手术，被排除在分析之外。在其余35例手术中，15例（42.9%）需要额外增加切口才能完成。性别、年龄、体重指数、脾脏重量、手术指征以及副脾的存在均与是否需要增加切口无关。唯一具有统计学意义的因素是SIPES接入装置中的通道数量（p = 0.002）。
SIPES脾切除术的完成与使用具有四个通道的接入装置的决定有关。解剖变量似乎并未影响完成SIPES脾切除术的能力。
