Laparoscopic single site surgery: initial experience and description of techniques in the pediatric population

Purpose: Recently new approaches to laparoscopic surgery, named natural orifice transluminal endoscopy and laparoendoscopic single site surgery, have been proposed to improve the cosmesis and decrease the morbidity associated with multiple ports sites. Experience with laparoendoscopic single site surgery technique in pediatric urology is still limited. We present our initial results with this technique in children.

Materials and methods: Since laparoendoscopic single site surgery received Food and Drug Administration approval, 11 patients have undergone a total of 14 procedures at our department, including nephrectomy due to nonfunctioning kidneys in 4, removal of bilateral intra-abdominal gonads in 2, unilateral varicocelectomy in 4 and bilateral varicocelectomy in 1. In all patients a multi-channel single laparoscopic port inserted through a 2 cm skin incision was used to achieve access to the abdominal cavity.

Results: All patients underwent laparoendoscopic single site surgery without complications within a reasonable operative time. None required conversion to open or conventional laparoscopic surgery. All except 1 patient were discharged home on the day of surgery or the day after surgery.

Conclusions: Our initial data show that laparoendoscopic single site surgery is an effective technique for various pediatric and adolescent urology indications. Further application of this procedure in a large patient group will show whether there is a place for laparoendoscopic single site surgery in the pediatric urology surgical armamentarium.