Faculty Collaboration Database

Single cannula technique and robotic telescopic assistance in infants and children who require laparoscopic Nissen fundoplication. J Pediatr Surg 2003 Jan;38(1):111-5; discussion 111-5

Date

02/20/2003

Pubmed ID

12592631

DOI

10.1053/jpsu.2003.50022

Scopus ID

2-s2.0-0037239891 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

BACKGROUND/PURPOSE: Laparoscopic Nissen fundoplication (LNF) is being utilized more extensively in the management of symptomatic gastroesophageal reflux disease in infants and children. The traditional approach utilizes 5 3- to 5-mm cannulas for telescope and instrument access to the peritoneal cavity. The purpose of this study is to report the technique and document the results using a single 5-mm umbilical cannula for LNF, stab incisions for placement of the instruments, and robotic telescope assistance.

METHODS: From November 1999 through March 2002, 154 patients underwent LNF by the senior author for pathologic gastroesophageal reflux disease. All operations were performed with a single 5-mm umbilical cannula through which a 4- or 5-mm telescope was placed for operative visualization. Four stab incisions were made through the upper/lateral abdominal wall under direct visualization avoiding the epigastric vessels. Through these stab incisions, instruments were inserted into the peritoneal cavity. The maximum insufflation pressure was 15 mm Hg in all cases. The ability to perform the procedure in the absence of additional operative cannula placement, complications during instrument insertion, the ability to maintain adequate pneumoperitoneum, the patient's age, weight, operating time, and the addition of a gastrostomy were recorded.

RESULTS: All but one of the 154 LNFs were completed successfully using this technique. The mean age at operation and mean operating time was 23.9 months (range, 3 weeks to 180 months) and 91 minutes (31 to 160 minutes), respectively. Patients weight ranged from 2.4 to 57 kg (mean, 10.4 kg). Gastrostomies were placed in 52 cases. There were no complications associated with the stab incisions or insertion of the operative instruments through the abdominal wall. Pneumoperitoneum was maintained adequately in all cases.

CONCLUSIONS: LNF can be performed safely and effectively with a single umbilical cannula. We recommend its use for pediatric patients who require LNF.

Author List

Ostlie DJ, Miller KA, Woods RK, Holcomb GW 3rd

Author

Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Catheterization
Child
Child, Preschool
Fundoplication
Gastroesophageal Reflux
Humans
Infant
Infant, Newborn
Laparoscopes
Laparoscopy
Pneumoperitoneum, Artificial
Robotics
Umbilicus