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Feasibility of left subcostal single-incision laparoscopic surgery for pediatric left retroperitoneal space-occupying
Wu Yurui1, Cao Zhenhua1, Chen Meng1
1Department of Thoracic Surgery and Surgical Oncology, Capital Center for Children's Health, Capital Medical University, Beijing, 100020, China.
Objective:
To evaluate the technical feasibility, safety, and preliminary efficacy of left subcostal single-incision laparoscopic surgery (LS-SILS) in the right lateral position for various left retroperitoneal space-occupying lesions in children.
Methods:
This single-center, retrospective, observational case series analyzed 12 consecutive pediatric patients with left retroperitoneal space-occupying lesions who underwent LS-SILS between January and December 2025. All procedures were performed through a 1.5-2.0 cm single incision in the left subcostal region with the patient positioned at approximately 70° right lateral decubitus. We used a disposable single-port multi-channel laparoscopic access device [Si Ai De (Xiamen) Medical Equipment Co., Ltd., China; model: IIIA-3B-35 × 100] and conventional straight laparoscopic instruments. Perioperative outcomes and pathological results were analyzed.
Results:
All 12 procedures were successfully completed via the single incision without conversion to open surgery or additional trocar placement. Pathological diagnoses included: extralobar pulmonary sequestration (n = 6), solid pseudopapillary neoplasm of the pancreas (n = 2), adrenal neuroblastoma (n = 1), retroperitoneal mature teratoma (n = 1), lymphatic malformation with infection (n = 1), and adrenal mixed ganglioneuroblastoma with retroperitoneal metastasis (n = 1). Median operative time was 83.5 min, and median estimated blood loss was 7.5 mL. 9 patients resumed oral intake on the day of surgery, with a median postoperative hospital stay of 3 days. No pancreatic fistula occurred in the 2 pancreatic surgery patients. Notably, one patient with adrenal mixed ganglioneuroblastoma and retroperitoneal metastasis underwent complete single-stage resection of both lesions through the same incision, with uneventful recovery.
Conclusions:
LS-SILS in the right lateral position is a safe and feasible innovative minimally invasive technique for pediatric left retroperitoneal lesions. Through optimized positioning and incision design, it provides clear exposure and precise access to both left retroperitoneal and retroperitoneal lesions, demonstrating excellent technical expandability and significant clinical potential.
