Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France.
Department of Pediatric General Surgery and Urology, University Hospital, Federico II, Naples, Italy.
J Robot Surg. 2023 Feb;17(1):215-221. doi: 10.1007/s11701-022-01419-4. Epub 2022 May 27.
Incisions in the supra-pubic region have been described robotic-assisted surgery to improve cosmetic results in adults, but seldom in children. We aimed to present an innovative trocar placement in the Pfannenstiel line, named Scarless Laparoscopic Incisions in Pfannenstiel (SLIP), and evaluate its feasibility for various intra-abdominal procedures and its cosmetic results in pediatric robotic surgery. We performed a monocentric prospective study, including children undergoing robotic-assisted surgeries using a SLIP approach (July 2019-September 2021). Data regarding demographics, surgery, and outcome were collected and reported as median (range), or number (percentage). Cosmetic results were evaluated with a questionnaire. A SLIP approach was performed in 50 children (24 cholecystectomies, 12 splenectomies, 2 cholecystectomies and splenectomies, 9 colonic resections, 2 choledochal cyst resections, and 1 pancreatic pseudocyst resection). Median age was 11 years (2-18) and median weight 35 kg (10.5-80). Conversion to laparoscopy occurred in two cases. Post-operative complications occurred in 5 patients (10%), after colectomies [intrabdominal abscess (n = 3), stoma dysfunction (n = 1), parietal abscess (n = 1)], of which 3 (6%) required reintervention (intrabdominal abscess n = 2, stoma dysfunction n = 1). Regarding scars, 68% (n = 28) of parents and patients reported the maximal score of 5/5 for global satisfaction and 63% (n = 26) had all scars hidden by underwear. SLIP approach is versatile and can be used in supra- and infra-mesocolic robotic-assisted procedures. The low complication rate shows its safety in both young children and teenagers and does not increase operative difficulties. It results in high patient satisfaction regarding scars, and a scarless abdomen.
耻骨上方区域的切口已被描述为用于改善成人美容效果的机器人辅助手术，但在儿童中很少见。我们旨在提出一种在 Pfannenstiel 线的创新套管放置方法，命名为Pfannenstiel 无疤痕腹腔镜切口（SLIP），并评估其在小儿机器人手术中进行各种腹腔内手术的可行性及其美容效果。我们进行了一项单中心前瞻性研究，包括接受 SLIP 方法进行机器人辅助手术的儿童（2019 年 7 月至 2021 年 9 月）。收集并报告了人口统计学，手术和结果的数据，中位数（范围）或数量（百分比）。通过问卷调查评估美容效果。在 50 名儿童中进行了 SLIP 方法（24 例胆囊切除术，12 例脾切除术，2 例胆囊切除术和脾切除术，9 例结肠切除术，2 例胆总管囊肿切除术和 1 例胰腺假性囊肿切除术）。中位年龄为 11 岁（2-18 岁），中位体重为 35 公斤（10.5-80 公斤）。有两例转为腹腔镜手术。5 例患者（10％）发生术后并发症（3 例结肠切除术，[腹腔脓肿 n = 3，造口功能障碍 n = 1，壁脓肿 n = 1]），其中 3 例（6％）需要再次干预（腹腔脓肿 n = 2，造口功能障碍 n = 1）。关于疤痕，68％（n = 28）的父母和患者报告总体满意度得分为 5/5，63％（n = 26）的所有疤痕均被内衣隐藏。SLIP 方法用途广泛，可用于膈上和膈下机器人辅助手术。低并发症发生率表明其在幼儿和青少年中均安全，并且不会增加手术难度。它使患者对疤痕和无疤痕的腹部高度满意。
