RESUMEN
BACKGROUND/PURPOSE: One-trocar surgery (OTS) includes all video-surgical techniques performed using a single 10-mm port and an operative scope. These techniques can be completely endoscopic or endoscopic assisted. Since 1997, OTS has become the approach of choice in our institution for a variety of laparoscopic, retroperitoneoscopic, and thoracoscopic operations. We report our experience with this technique. METHODS: Four hundred fifty-eight patients (age range, 3 months to 17 years) underwent OTS from October 1997 to December 2008. The procedures were transumbilical laparoscopic-assisted (TULA) appendectomy (182 patients), TULA small bowel resection (14 patients), TULA intestinal biopsies (7 patients), laparoscopic adhesiolysis (6 patients), laparoscopic-assisted liver biopsies (5 patients), laparoscopic revision of peritoneal dialysis catheter (3 patients), retroperitoneoscopic varicocelectomy (202 patients), retroperitoneoscopic-assisted renal biopsies (4 patients), retroperitoneoscopic drainage of posttraumatic urinoma (1 patient), retroperitoneoscopic-assisted pyeloplasty (15 patients), and thoracoscopic pleural debridement and decortication for empyema (19 patients). RESULTS: The procedure was completed using only one trocar in 399 cases (87.1%). All conversions to multitrocar or open surgery were elective and regarded the retroperitoneoscopic approach during the learning curve (28 of 222, 12.6%; 21 varicocelectomies and 7 pyeloplasties) and the TULA appendectomy because of the appendix mobilization failure (31 of 182, 17%). There were no intraoperative or postoperative complications related to OTS. Wound infection was observed after two TULA appendectomies (1.3%). CONCLUSIONS: According to our experience, OTS is a feasible and versatile technique in pediatric surgery, providing a safe, effective, and the least invasive treatment for several different diseases.
Asunto(s)
Endoscopía/métodos , Adolescente , Niño , Preescolar , Endoscopios , Diseño de Equipo , Humanos , Lactante , Estudios RetrospectivosRESUMEN
UNLABELLED: Delayed upper gastrointestinal (UGI) bleeding after surgery is a catastrophic event with high mortality unless diagnosed early. In this paper, report a case of massive UGI bleeding 1 month after the laparoscopic treatment of a forme fruste choledochal cyst (FFCC). CASE REPORT: A 8-year-old girl presented at our attention because of acute pancreatitis. Ultrasound and magnetic resonance cholangiopancreatography diagnosed an FFCC. Once serum amylase and lipase were normal, a laparoscopic extrahepatic bile duct excision (EHBD) with a Roux-en-Y hepaticojejunostomy was performed without intraoperative complication. One month later, the patient had massive UGI bleeding, and laparotomic treatment of duodenal bleeding was necessary because of hemodynamic instability. Despite intravenous omeprazole and somatostatin, 1 week later, a new massive UGI bleeding occurred during hospitalization and an antral gastric resection with gastrojejunostomy (Billroth II) was performed. The patient was discharged 3 weeks later and she is well at 18-months of follow-up. EHBD excision with a Roux-en-Y hepaticojejunostomy is the treatment of choice for FFCC; laparoscopic approach is feasible and effective in children, too. The severe complication reported seems not related to the minimal invasive approach; in fact, it can occur after pancreatic or biliary surgery.
Asunto(s)
Quiste del Colédoco/cirugía , Hemorragia Gastrointestinal/cirugía , Laparoscopía/métodos , Complicaciones Posoperatorias/cirugía , Niño , Quiste del Colédoco/diagnóstico , Diagnóstico Diferencial , Femenino , Hemorragia Gastrointestinal/etiología , HumanosRESUMEN
Retroiliac ureter is a rare congenital anomaly. In this paper, we present a case in which retroiliac double ureters were incidentally found during a retroperitoneoscopic nephroureterectomy procedure in a 5-year-old boy with dysplastic right kidney in duplex system and ureterocele. Ureters were both in the retroiliac artery position. The nephroureterectomy procedure was completed retroperitoneoscopically. After a literature review, this case appeared to be the first report of retroiliac double ureters in a duplex system.
Asunto(s)
Hallazgos Incidentales , Riñón/anomalías , Uréter/anomalías , Preescolar , Dilatación Patológica , Humanos , Laparoscopía , Masculino , Uréter/patologíaRESUMEN
AIM: The laparoscopic treatment of paediatric appendicitis remains controversial, especially in the presence of complications. This study evaluated the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) by analysing the data from a multicentre study. METHODS: The authors retrospectively reviewed a series of 2,332 appendectomies (1,506 LA and 826 OA) performed in children and adolescents (median age 8 years) in 9 different centres of paediatric surgery. For the patients operated using laparoscopy, an IN procedure was employed in 921 (61.2%), an OUT procedure in 571 (37.9%) and a MIXED procedure in 14 (0.9%). In the open surgery, a McBurney incision was adopted in 795 patients (96.4%). RESULTS: Median duration of surgery was 40 minutes for LA and 45 minutes for OA. Median hospital stay was 3 days (LA) and 4.3 days (OA) in case of simple appendicitis and 5.2 days (LA) and 8.3 days (OA) in case of peritonitis. Complications were recorded in 124 LA cases (8.2%) and 65 OA cases (7.9%). The conversion rate in laparoscopy was only 1.6% (25 cases). The statistical analysis was performed using the Mann-Whitney test, and the main significant difference that emerged was the length of hospital stay, which was in favour of laparoscopy compared with open surgery (P < 0.0001). CONCLUSIONS: We conclude that in clinical settings where laparoscopic surgical expertise and equipment are available and affordable, LA seems to be an effective and safe alternative to OA. Three out 9 centres participating in our survey perform LA in all patients with a suspicion of appendicitis. Our study shows that laparoscopy significantly reduces hospital stay in case of appendicitis and peritonitis and presents an extremely low conversion rate (1.6%) to open surgery. Laparoscopic transumbilical appendectomy (37.9%) in our series seems to be a simple option, even for less-skilled laparoscopic surgeons.
Asunto(s)
Apendicectomía/métodos , Apendicitis/cirugía , Laparoscopía , Adolescente , Apendicitis/complicaciones , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND/PURPOSE: In the pediatric population the failure rate of sclerotherapy for the treatment of varicocele has been reported to be up to 35%. Therefore, the aim of our study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in children and adolescents. METHODS: A total of 97 patients were operated on for left-sided varicocele using the retroperitoneoscopic approach between January 1999 and July 2003. Median age was 12.3 years (range, 6-16 years). A 10-mm subcostal retroperitoneoscopic port was used. The operation was performed through an operative laparoscope according to Palomo's technique, with the mass division of spermatic vessels after bipolar coagulation below the renal vein. Elective conversion to laparoscopic transperitoneal varicocelectomy was performed in cases of difficulties in identifying the vessels. The postoperative follow-up included clinical and ultrasound assessment (range, 6-48 months). RESULTS: A total of 17 (17.6%) patients needed elective conversion to laparoscopic transperitoneal varicocelectomy. In RV, the mean operative time was 28 minutes (range, 15-55 minutes), the mean hospital stay was 2 days, persistence rate was 11.2%, and hydrocele occurrence was 6.2%. CONCLUSIONS: Our results indicate that the RV is an acceptable technique to achieve the high division of the spermatic vessels. The advantage of this anatomic approach is its very low invasiveness.
Asunto(s)
Laparoscopía , Varicocele/cirugía , Adolescente , Niño , Procedimientos Quirúrgicos Electivos , Electrocoagulación , Estudios de Seguimiento , Humanos , Periodo Intraoperatorio/estadística & datos numéricos , Laparoscopía/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Hidrocele Testicular/epidemiología , Hidrocele Testicular/etiología , Resultado del TratamientoRESUMEN
PURPOSE: Diagnostic laparoscopy has changed the surgical approach to nonpalpable testes (NPT). The aim of this study was to determine the value of laparoscopy in managing patients with NPT and to suggest guidelines for the interpretation of laparoscopic findings. The authors report the results of a multicenter study of the Italian Society of Video Surgery in Infancy on laparoscopic management of NPT. METHODS: Between 1993 and 2001, the authors collected records of 364 patients with NPT who underwent laparoscopy, for a total of 388 testicular units. RESULTS: Intraabdominal testes were found in 124 (34%) cases, for a total of 137 testes; 83 testicular units were classified as low and 54 as high. A total of 155 (43%) patients had cord structures entering the internal inguinal ring, 79 (22%) had intraabdominal blind-ending cord structures, and 6 (1%) had testicular agenesia. CONCLUSIONS: Laparoscopy is a valuable tool in diagnosing and treating more than 50% of cases of NPT. The laparoscopic evaluation of abdominal testes can provide indications for the most suitable surgical technique; moreover, in 23% of patients, it makes abdominal exploration unnecessary. The value of laparoscopy is even greater if the anatomical aspect of the internal ring and spermatic cord structures is carefully evaluated.
Asunto(s)
Criptorquidismo/cirugía , Laparoscopía/métodos , Cirugía Asistida por Video/métodos , Criptorquidismo/diagnóstico , Humanos , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: We evaluate the results and complications of laparoscopic urological procedures in children. MATERIALS AND METHODS: In a 3-year period 4,350 laparoscopic procedures were performed at 8 Italian centers of pediatric surgery. We analyzed only the data of urological procedures for a total of 701 laparoscopic operations on patients 1 month to 14 years old. The indications for surgery were cryptorchidism in 414 cases, varicoceles in 159, ambiguous genitalia in 37, total nephrectomy in 34, partial nephrectomy in 4, adrenalectomy in 3 and other diagnostic procedures in 50. We adopted a retroperitoneoscopic approach in 72 cases (10.3%) and a laparoscopic approach in 629 (89.7%). Patient records were analyzed to search for any complication that may have occurred during the laparoscopic procedure and assess how they were managed. RESULTS: We recorded 19 complications (2.7%) in our series, of which 6 required conversion to open surgery and 13 did not. There was no mortality. At a maximum followup of 4 years all children were alive and had no problems related to the laparoscopic complications. CONCLUSIONS: Our study shows that pediatric laparoscopic urological surgery has an acceptable rate of complications with no mortality. We believe that routine use of open laparoscopy in pediatric patients is a key factor to help avoid complications. Most complications can be avoided with surgeon and team experience, together with proper compliance with the indications for surgery.