Single-port laparoscopic surgery: initial experience in children for varicocelectomy
Article first published online: 5 MAR 2008
© 2008 THE AUTHORS. JOURNAL COMPILATION © 2008 BJU INTERNATIONAL
Volume 102, Issue 1, pages 97–99, July 2008
How to Cite
Kaouk, J. H. and Palmer, J. S. (2008), Single-port laparoscopic surgery: initial experience in children for varicocelectomy. BJU International, 102: 97–99. doi: 10.1111/j.1464-410X.2008.07584.x
- Issue published online: 5 MAR 2008
- Article first published online: 5 MAR 2008
- Accepted for publication 19 December 2007
- scarless surgery
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.
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.
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.