Single incision laproscopic surgery (SILS) involves performing abdominal operations
with laparoscopic instruments placed through a single, small umbilical incision. The
primary goal is to avoid visible scarring. This is the first report of SILS cholecystectomy
in children and the first report in the literature of SILS splenectomy.
A retrospective chart review was performed in 20 consecutive inpatient SILS procedures
(13 males, 7 females; ages 2-17 years) from May to December 2008. Outcome measures
included need for conversion, operative time, time to oral analgesia, length of hospitalization,
cosmetic outcome, and complications.
There were 4 total splenectomies, 3 cholecystectomies, 2 combined splenectomy/cholecystectomies,
and 11 appendectomies performed. All procedures were completed successfully without
need for conversion to standard laparoscopy or open surgery. Mean operative time was
90 minutes for splenectomy, 68 minutes for cholecystectomy, 165 minutes for combined
splenectomy/cholecystectomy, and 33 minutes for appendectomy. Mean hospital stay was
1 day for appendectomy, 1 day for cholecystectomy, and 2.5 days for splenectomy. One
splenectomy patient received 1 U packed red blood cell transfusion. All appendectomy
patients were converted to oral analgesia within 24 hours and splenectomy patients
within 48 hours. All families were very pleased with the cosmetic outcome.
Single incision laparoscopic surgery is feasible for a variety of pediatric general
surgical conditions, allowing for scarless abdominal operations. This early experience
suggests that outcomes are comparable to standard laparoscopic surgery but with improved
cosmesis, however, a larger series is necessary to confirm these findings and to determine
if there are any benefits in pain or recovery. Surgeons performing SILS should have
a firm foundation of advanced minimal access surgical skills and a cautious, gradated
approach to attempting the various procedures. Technological refinements will further
enable SILS.