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Pediatric single incision laparoscopic cholecystectomy: lessons learned in the first 25 cases
Claudia N Emami1, Deiadra Garrett, Dean Anselmo
1Department of Pediatric Surgery, USC-Keck School of medicine, Childrens Hospital Los Angeles, 4650 Sunset Blvd, MS#100, Los Angeles, CA 90027, USA. claudia.emami@gmail.com
Insights
Single incision laparoscopic cholecystectomy in children is safe and feasible. This minimally invasive approach offers excellent cosmetic results and a short hospital stay, making it suitable even for acute cases.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Laparoscopic cholecystectomy is a standard procedure for gallbladder removal.
- Minimally invasive techniques aim to reduce patient morbidity and improve cosmetic outcomes.
- Single incision laparoscopic surgery (SILS) represents a further advancement in minimizing surgical invasiveness.
Purpose of the Study:
- To evaluate the safety and feasibility of single incision laparoscopic cholecystectomy (SILS) in pediatric patients.
- To assess key outcomes including operative time, length of stay, and postoperative pain management.
- To determine the cosmetic results of SILS in pediatric gallbladder surgery.
Main Methods:
- A retrospective chart review was conducted for pediatric patients undergoing SILS between January 2008 and October 2009.
- Data collected included operating room (OR) times, length of hospital stay, and intravenous narcotic requirements.
- The SILS procedure involved a single infra-umbilical incision with three 5-mm ports.
Main Results:
- Twenty-five pediatric patients underwent SILS, with a female predominance (20 females, 5 males).
- Average OR time was 97.5 minutes, comparable to traditional 4-port procedures, with minimal blood loss and no intra-operative complications.
- Mean length of stay was 1.47 days, with minimal need for postoperative IV narcotics and excellent cosmetic outcomes.
Conclusions:
- Single incision laparoscopic cholecystectomy is a safe and feasible surgical option for pediatric patients.
- SILS provides satisfactory cosmetic results and clinical outcomes in children, even for acute gallbladder disease.
- This approach represents a viable advancement in minimally invasive pediatric surgery.
Purpose:
We are reporting our experience so far with single incision laparoscopic cholecystectomy in children.
Methods:
After the approval of the institutional review board, we performed a retrospective chart review of our single port cases from 01/2008 to 10/2009. We used operating room (OR) times, length of stay, as well as IV narcotic use as our outcome measures. Pertinent clinical data were extracted. The single port procedure was performed using a single infra-umbilical incision whereby three 5-mm ports were placed.
Results:
We identified 25 patients in the single port group (20 females and 5 males). 23 patients in the study group underwent cholecystectomy without intra-operative cholangiogram and one patient had an intra-operative cholangiogram performed. This additional procedure did not add to the overall OR time significantly as compared to simple cholecystectomies. Average OR time was 97.5 min as compared to 71.4 min in the traditional 4-port group. Blood loss was reported as minimal for all cases in both the groups (5-25 ml). There were no intra-operative complications in either group. Mean length of stay was 1.47 days in the study group. All patients in the study group had minimal (1-3 doses) need for intravenous narcotics during their inpatient stay except for one patient, who required more. All patients in the study group had excellent cosmetic results on postoperative follow-up.
Conclusion:
Single incision laparoscopic cholecystectomy is safe and feasible to perform in pediatrics, even in the setting of acute disease.