Umbilical two-port laparoscopic percutaneous extraperitoneal closure for patent processus vaginalis in boys: incision-hiding and solo-like surgery

Abstract

Background Transumbilical two-port laparoscopic percutaneous extraperitoneal closure for the treatment of processus vaginalis patency in boys has been practising recent years. The applicable instruments and skills are still evolving. In this study, we used a self-made needle assisted by a disposable dissecting forceps to practise this minimal invasive method for patent processus vaginalis in boys. Its safety and effectiveness were studied. The methods for depth and orientation perceptions were analyzed. Methods From January 2020 to November 2020, boys characteristic of symtomatic patency of processus vaginalis were performed open surgery consecutively. From December 2020, the authors begun to propose transumbilical two-port laparoscopic percutaneous extraperitoneal closure for this kind of boy patients. The open group included fifteen boys and the laparoscopic group included ten ones. The data of the patients age, constituent ratios of unilateral and bilateral patency, operating time, postoperative stay in hospital, follow-up time, conversion, postoperative complications were assessed. Throughout the laparoscopic process, the parallel and synchronous movements of lens pole and dissecting forceps were maintained. Vas deferens protrude was imagined as one of the point to form the triangular manipulation plane. Results There were no statistically significant difference between the laparoscopic group and the open group for the following items: age, operating time, the constituent ratios of unilateral or bilateral patency of processus vaginalis (P > 0.05). Postoperative stay in hospital and follow-up time of the laparoscopic group was significantly shorter than that of the open group (P = 0.0000). No laparoscopic case was converted to open surgery. After 10 cases of laparoscopic practice, orientation perception was established. There were no postoperative complications for all the patients. Conclusion Our preliminary experience suggested that umbilical two-port laparoscopic percutaneous extraperitoneal closure is safe and convenient for patent processus vaginalis treatment in boys. It has the advantage of incision-hiding and can be manipulated like a solo-like surgery.

Needle consideration in umbilical two-port laparoscopic percutaneous extraperitoneal closure for patent processus vaginalis of children: hook-needle or forcep-needle

“…In our previous research of single-port umbilical LPEC for girls with an epidural needle [23], when piercing the needle, we used the towel forceps to pull the abdominal wall to enhance the spatial orientation perception and eye-hand coordination. Similarly, in the practice of umbilical single-site two-port LPEC for children, in order to conquer the instrumental collisions in the limited umbilical space, we actioned the two poles synchronously parallelly and sagittally to form a solo-like surgery fashion [24]. A central holed needle could accomplish the internal ring being encircled by a common silk thread.…”