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Experience with the Exclusive Use of 5 mm Instruments for Paediatric Laparoscopy (Abstract)

Anies Mahomed, Stephen Adams

Department of Paediatric Surgery, Royal Alexandra Children’s Hospital, Brighton,

United Kingdom

 

Abstract

Background: For a paediatric surgical unit offering minimally invasive surgery it would seem essential to have both 3 and 5mm instruments. For a multitude of reasons a complete set of 3mm instruments was unavailable in our institution, for a period, thus making surgeons completely reliant on 5mm sets to deliver the service. Described are the technical modifications implemented to enable safe usage of 5mm sets in paediatric patients

Material and Methods: Presented is a single surgeon’s experience between January 2004 and January 2008. Adaptations that were utilised, included amongst others: appropriate port placement and fixation to body wall using a sleeve designed from suction tubing, optimising CO2 insufflation pressure and utilising camera guided decompression of intra-abdominal cysts to increase operating space, utilising monopolar hook diathermy device with its fine tip for almost all dissection and diathermy control, use of external traction sutures to limit the number of ports and adjusting zoom control on the videocamera to improve the width of view.

Results: A total of 157 laparoscopic cases were performed during the period of review. These included 44 appendicectomies, 30 fundoplications, 18 cholecystectomies and 11 transperitoneal nephrectomies/heminephrectomies. Ages ranged from 2 months to 19 years (mean 9.05 years), weight from 3.1 to 120 kg’s and 8.3% of all cases were less than 1 year of age. In the 2 largest groups (appendicectomy and fundoplications) mean operating times were 45mins (range 35 -100 min. SD 17.23) and 124mins (range 60-315 min. SD 48.43) respectively. There was no mortality and no conversions. Two cases complicated, both these children made uneventful recoveries after further surgery.

Conclusions: In experienced hands 5mm instruments pose no impediment to safely undertaking a near comprehensive range of laparoscopic procedures across all ages in children. However there are limitations as is apparent by our lack of progress with advanced thoracic surgery such as that involving lung resection and tracheo-oesophageal fistula repair in infants. For almost all other surgery in children, with subtle modification, 5mm sets may be employed with relative safety.

Key words: laparoscopy, infant, paediatric, 5mm sets, adaptation of technique

 

 

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