Single Incision Pediatric Endoscopic Surgery: From Myth to Reality a Case Series

Abstract

Laparoscopic surgery has continued to evolve to minimize access sites and scars in both the adult and pediatric populations. In children, single-incision pediatric endoscopic surgery (SIPES) has been shown to be effective, feasible, and safe with comparative results to multiport equivalents. Thus, the use of SIPES continues over increasingly complex cases, however, conceptions of its efficacy continue to vary greatly. In the present case series and discussion, we review the history of SIPES techniques and its current application today. We present this in the setting of five common myths about SIPES techniques: limitations against complex cases, restrictions to specialized training, increased morbidity outcomes, increased operative lengths, and increased operative costs. Regarding the myth of SIPES being limited in application to simple cases, examples were highlighted throughout the literature in addition to the authors’ own experience with three complex cases including resection of a lymphatic malformation, splenectomy with cholecystectomy, and distal pancreatectomy with splenectomy. A review of SIPES learning curves shows equivalent operative outcomes to multiport learning curves and advancements towards practical workshops to increase trainee familiarity can help assuage these aptitudes. In assessing comorbidities, adult literature reveals a slight increase in incisional hernia rates, but this does not correlate with single-incision pediatric data. In experienced hands, operative SIPES times average approximate multiport laparoscopic equivalents. Finally, regarding expenses, SIPES represents an equivalent alternative to laparoscopic techniques.

Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis—A Systematic Review and Meta-Analysis

“…Since their introduction, laparoscopic procedures have been performed extensively in both pediatric and adult surgery. 10,13 As a result of their availability, expertise in laparoscopy is constantly increasing. This fact must be taken into account when comparing older studies with more recent work.…”

“…10 Since then, minimal invasive surgery has developed a lot with common, but also highly specialized surgical procedures performed laparoscopically. [11][12][13][14] At present, most specialized centers use the laparoscopic access route for pyloromyotomy, which was first described in 1990. 15 Whether laparoscopic pyloromyotomy (LP) is superior to open pyloromyotomy (OP) has been debated and reviewed by many pediatric surgeons.…”

Single Incision Laparoscopic Surgery (SILS) in Small Animals: A Systematic Review and Meta-Analysis of Current Veterinary Literature

“…From the meta-analysis, the only report registering a significantly lower surgical time for SILS than for multiport techniques in OVE procedures was by Gonzalez-Gasch and Monnet [ 21 ] who described the use of a SILS port system. In human medicine, meta-analysis showed comparable operative times for colectomies, nephrectomies, and splenectomies [ 43 , 44 , 45 ] and increased operative times using a single-incision approach in appendectomies and cholecystectomies [ 46 , 47 ]. However, there is significant statistical heterogeneity in these comparisons, and all of these studies can be subject to self-selection bias [ 48 ].…”