Single‐port laparoscopic surgery: initial experience in children for varicocelectomy

Abstract

OBJECTIVE To present our initial experience in children undergoing single‐port laparoscopic varicocelectomy (SPLV) using a new approach in which the entire procedure is performed through a multichannel single laparoscopic port inserted in the umbilicus rather than the traditional LV performed through three abdominal ports. PATIENTS AND METHODS We reviewed our experience with all paediatric patients who had undergone transumbilical SPLV [Uni‐XTM Single Port Access Laparoscopic System, Pnavel Systems, NJ, USA]. This novel 20‐mm laparoscopic port has three working channels and gas insufflation access. The system also includes a variety of curved laparoscopic instruments that can be introduced through the SP. A Hassan technique through an incision within the inferior aspect of the umbilicus is used to obtain laparoscopic port access to the abdominal cavity. The SP is then fixed into position with pre‐placed rectus facial sutures. Using a curved laparoscopic grasper and scissors, an incision is made within the posterior peritoneum on the medial and lateral aspects of the left testicular artery and veins, proximal to the vas deferens. The vessels, both artery and veins, are transected leaving clips both proximally and distally. RESULTS Transumbilical SPLV was completed in three consecutive adolescents (aged 13, 15 and 16 years) without placing any additional ports or conversion to open surgery. All procedures were performed for left‐sided grade III varicoceles. The operative duration was <1 h for each procedure. All patients were discharged on the same day as their surgery and none required re‐hospitalization. At a mean (range) follow‐up of 8.7 (6–10) weeks there was a good cosmetic result, with no varicocele recurrence, or intraoperative or postoperative complications including wound infection, hydrocele, or incision site herniation. CONCLUSION We report the first use of a multicannula single laparoscopic port in children and for SPLV. This new laparoscopic approach, similar to any new technique, requires further experience to fully evaluate its benefits and limitations.

Single Port Access Laparoscopic Cholecystectomy (with video)

“…Whereas SPA laparoscopy has been looked at as a possible derivative of NOTES, it has, at this time, the advantage of a lower complexity for clinical application to allow the use of standard laparoscopic instruments [11,[18][19][20]. Its only complexities are represented by the necessity to operate in-axis and with low possibility of triangulation, which is similar to NOTES until now [9,10,[21][22][23][24].…”

Patient-reported satisfaction and cosmesis outcomes following laparoscopic adrenalectomy: laparoendoscopic single-site adrenalectomy vs. conventional laparoscopic adrenalectomy

“…3 LESS surgery has been done for various urological diseases involving adrenal tumour, and studies of prospective outcomes show less pain, shorter hospital stays and excellent cosmetic outcomes. [4][5][6][7][8][9] However, evaluation of LESS surgery cosmesis has largely entailed subjective operator assessment 3,[10][11][12][13] with objective evaluations limited by small sample sizes and evaluation as a secondary endpoint.…”

Pure NOTES Transvesical Venous Ligation: Translational Animal Model of Varicocelectomy

“…15 NOTES represents an appealing concept to pursue in minimally invasive procedures and it is currently in its early stages of development in visceral surgery. 6,16 To bring it closer to the routine clinical setting, the ideal way to access the peritoneal cavity through a natural orifice remains to be determined.…”