In the last few years, a lot of studies and reports from different parts of the world showed the feasibility of SILS in children regarding many types of operations. The results were nearly close or equal to multiport laparocopy according to these studies. We tried SILS in 4 cholecystectomy operations but we did not find it superior to the conventional laparoscopy. Your comments are welcomed regarding SILS.
I think it is obviously less easy than multiport procedure but as usual, get easier as more you do it. The benefit is only , in my opinion, the scar which is undectectable when the incision is well done in the umbilicus, even if you need a little vertical extension (by cheating when you close it, like in umbilical incision in pyloric stenosis) and the possibility to extract the gallbladder ou whatever you remove (a kidney for exemple, when you have to remove it before a renal transplantation) through the protected openig. Not superior yet, but at least equal and in my opinion sometime useful.
El gran avance fue de la cirugia abierta a la laparoscopica , tengo 20 años practicando la cirugia laparoscopica en niños y creo que una o dos incisiones mas de 3 mm no hacen gran diferencia, no he practicado la de puerto unico porque no creo que sea buena opcion en niños.
El gran avance FUE de la cirugia abierta a la laparoscopica, Tengo 20 años practicando la cirugia laparoscopica en Niños y Creo Que Una o dos incisiones mas de 3 mm no Hacen gran Diferencia, no lo practicado la de puerto unico Porqué no Creo Que sea buena opcion en Niños dada las cavidades pequeñas en los bebes.
SILS in ped surgery provides in simple procedures like appendicitis some benefit. As to my scarce knowledge main advantage which SILS should provide is only one relatively small scar, other benefits are not really recognizable. But the future may be two SILS instead of 5, 6 ports for more complicated surgeries like redo fundos, staging operations and so on..
For the umbilical scar we do use a technique how to avoid the typical horizontal scar already since many years (published see attachment).
Article Transumbilical Access for Pneumoperitoneum (Modified Hasson ...
defenitely yes for appendectomy (but it's more a laparoscopic assisted procedure than relly SILS).
SILS is expensive ( special instruments if you want to make it a little bit easier) and more compicated than three trocars technic. 3mm trocars or less don't give any scar afterwoods and so, interest in chidren is poor in my opinion. We did some splenectomies , cholecystectomies but found it really more complicated and really not suitable in a teaching (Universitary Hospital); and the umbilical pain is sometimes really important.
Using the robot is probably the future but that is big, big money!
Article Umbilical one-puncture laparoscopic-assisted appendectomy in children
Well personally I don't have experience in SILS but extrapolating the experience of pediatric laparoscopy- I feel the late cosmetic outcome that can be achieved with SILS should keep the interest alive.
The down side is of course (as pointed out earlier)- cost factor. In neonates and infants 3mm instrument hardly leave any scar behind.
It is useful only when a region is to be operated Eg RIF/GE Junction etc. However when operating on a wider region as in Hirschprung's disease for example you have to deal with pelvis then ascend up (Depending on the length of aganglionosis) may be upto Transverse colon. This I feel may be technically difficult with SILS.
Of course proper case selection, situation where cost is not a bar............SILS would the option when patients are offered this form of laparoscopy.
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