Laparoendoscopic single site surgery in pediatric urology: does it require specialized tools?

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Laparoendoscopic single site (LESS) surgery offers potential benefits in pediatric urology.
• Evaluating the application and outcomes of LESS in pediatric urologic procedures is crucial.

Purpose of the Study:

• To describe the experience and outcomes of utilizing Laparoendoscopic single site (LESS) surgery in pediatric urology.
• To assess the feasibility and effectiveness of LESS for a range of urologic procedures in children.

Main Methods:

• Retrospective chart review of 54 LESS urologic procedures in 44 pediatric patients from November 2009 to March 2013.
• Procedures included nephrectomy, orchiopexy, varicocelectomy, orchiectomy, urachal cyst excision, and antegrade continence enema (ACE).
• Analysis of operative time, estimated blood loss (EBL), incision length, complications, and need for conversion or further procedures.

Main Results:

• Median patient age was 6.9 years; procedures ranged from varicocelectomy (56 mins) to bilateral nephroureterectomy (360 mins).
• Incision lengths were 2-2.5cm; initial use of a commercial port evolved to adjacent fascial punctures.
• Complications occurred in 6.8% of cases (3 patients), with two Clavien Grade 3b; one conversion to open surgery due to bleeding.

Conclusions:

• Laparoendoscopic single site (LESS) surgery is applicable to numerous pediatric urologic procedures, especially ablative and simple reconstructive ones.
• Employing adjacent fascial puncture sites for instrumentation can negate the requirement for commercial ports or multiple trocars.
• LESS demonstrates potential as a valuable minimally invasive approach in pediatric urology.