One-trocar surgery: A less invasive videosurgical approach in childhood

Background/Purpose: Laparoscopic techniques and instruments are evolving to lessen the invasiveness of this surgical approach. The authors present the ir experience with the videosurgical approach using only 1 trocar. Methods: Between October 1997 and January 2000 the authors performed 59 vid eosurgical procedures' using a 1-trocar approach (mean age, 11.5 years; ran ge, 4 to 18 years). A 10-mm Hasson trocar was inserted in an "open" fashion either through the umbilicus (laparoscopy) or below the apex of the 121h r ib (retroperitoneoscopy). An operative laparoscope was used in all cases. T he operations were 18 retroperitoneoscopic Palomo varicocelectomies, 1 retr operitoneoscopic renal biopsy, 38 appendectomies, and 2 ileal resections (M eckel's diverticulum, duplication cyst). For appendectomies and ileal resec tions, the corresponding intestinal loop was grasped and exteriorized throu gh the umbilicus to perform conventional surgery. Results: Mean operating time was 50.9 minutes (range, 30 to 120) for laparo scopies and 44 minutes (range, 15 to 80) for retroperitoneoscopy. There wer e 11 conversions (8 appendectomies, 3 varicocelectomies) and no postoperati ve complications. Conclusions: "One-trocar surgery" is safe, effective, and fast with a low c omplication rate and excellent cosmetic results. The authors believe it is the least invasive as well as the most effective approach in the treatment of varicocele, appendicitis, and selected intestinal diseases. J Pediatr Su rg 36:811-814. Copyright (C) 2001 by W.B. Saunders Company.