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The laparoscopic paradigm to place different ports according to ergonomic principles is presently challenged by laparoendoscopic single site surgery (LESS). Its objective is to perform a complex task with several instruments using only one access. However, this approach introduces distinct ergonomic problems and requires innovative technical solutions to allow for more complex surgical tasks. In paediatric surgery, this development has just begun. A 16-year-old girl presented with a symptomatic cholecystolithiasis. A multi-channel TriPort (Advanced Surgical Concepts) was introduced through a 20 mm umbilical incision for LESS cholecystectomy. Retraction of the gallbladder was facilitated by a straight grasper, which was inserted transabdominally. For exposition and triangulation a pre-bend dissector (5 mm, Olympus) was employed. Thus, the cystic duct and artery could be exposed, clipped (5mm) and divided. Finally, the gallbladder was dissected from its bed and extracted into a specimen bag. Operating time was 90 minutes and no intra- or postoperative complications occurred. In conclusion, a multi-channel port and angulated instruments during LESS cholecystectomy provided ergonomics close to conventional laparoscopic surgery. For smaller children though, this technology will have to be adapted to their geometry. Finally, even though LESS seems attractive, the present euphoria should not turn into scientific acceptance, until more experience is available and valid data have proven a benefit for patients of any age. |
