Department of General Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Hernia Surgery, Huangshan City People's Hospital, Huangshan, China.
Pediatr Surg Int. 2023 Oct 4;39(1):278. doi: 10.1007/s00383-023-05560-5.
The advantage of using the single-port technique over the conventional two-port approach is uncertain. This study aimed to evaluate the outcomes of a single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) using a modified needle grasper in children and compare the results to those of two-port laparoscopic percutaneous extraperitoneal closure (TLPEC).
A retrospective cohort analysis of SLPEC and TLPEC surgery from February 2016 to June 2021 was conducted at our institution. Pediatric patients underwent SLPEC using the modified needle grasper to complete the high ligation of the hernia sac, while operations in the conventional two-port group only used regular laparoscopic instruments. A 1:1 propensity score matching (PSM) analysis was used to reduce selection bias.
Of 1320 patients, 1169 were included in the single-port/two-port crude evaluation, with 930 in the PSM cohort (465 patients/arm). Among 1:1 matched patients, the operation time for single-port patients vs. two-port patients were 11.28 ± 3.98 vs. 15.47 ± 4.54 min for unilateral repair and 16.86 ± 4.59 vs. 20.40 ± 4.29 min for bilateral repair (p < .05). Cosmetic results did not differ between the SLPEC and TLPEC groups (0% vs. 0.7%, p = 0.249). The recurrence rates were comparable between the two groups (0.6% vs. 1.1%, p = 0.725). Moreover, the differences in surgical site infection (SSI), testicular atrophy, open conversion and postoperative hydrocele occurrence were insignificant between the two groups.
In this cohort study, the modified needle grasper is a safe and feasible instrument for SLPEC, and SLPEC using the needle grasper has a shorter operation time than TLPEC.
使用单端口技术相对于传统双端口方法的优势尚不确定。本研究旨在评估改良针抓钳在儿童中使用单端口腹腔镜经皮腹膜外闭合术（SLPEC）的结果，并将结果与双端口腹腔镜经皮腹膜外闭合术（TLPEC）进行比较。
对 2016 年 2 月至 2021 年 6 月在我院行 SLPEC 和 TLPEC 手术的患儿进行回顾性队列分析。采用改良针抓钳完成疝囊高位结扎，完成 SLPEC，而传统双端口组仅使用常规腹腔镜器械。采用 1:1 倾向评分匹配（PSM）分析以减少选择偏倚。
在 1320 例患儿中，1169 例纳入单端口/双端口粗评研究，930 例纳入 PSM 队列（每组 465 例）。在 1:1 匹配的患儿中，单端口组与双端口组的手术时间分别为单侧修补术的 11.28 ± 3.98 分钟与 15.47 ± 4.54 分钟，双侧修补术的 16.86 ± 4.59 分钟与 20.40 ± 4.29 分钟（p<0.05）。SLPEC 组和 TLPEC 组的美容效果无差异（0% vs. 0.7%，p=0.249）。两组的复发率相当（0.6% vs. 1.1%，p=0.725）。此外，两组的手术部位感染（SSI）、睾丸萎缩、中转开放和术后阴囊积水发生率无显著差异。
在本队列研究中，改良针抓钳是一种安全可行的 SLPEC 工具，使用针抓钳的 SLPEC 比 TLPEC 手术时间更短。
