Single-Incision Pediatric Endosurgery: A Systematic Review

Background: Single-incision pediatric endosurgery (SIPES) is defined as minimally invasive surgery performed through a unique incision in the abdomen, chest, or retroperitoneum. Several publications exist, but no previous systematic review has been made to evaluate the real benefits of this approach in terms of feasibility and clinical outcomes. Materials and Methods: We performed an electronic search in PubMed up to March 2012 with the terms "single AND incision OR site OR port OR trocar AND children'' including related articles and obtained 197 articles. After applying our inclusion criteria, 78 articles were reviewed. Results: We identified prospective controlled trials (n = 1), case-control studies (n = 12), case series (n = 49), and case reports (n = 16). In total, 4212 patients had been operated on by SIPES and were separated by systems: gastrointestinal (n = 2888), urologic (n = 390), gynecologic (n = 27), other abdominal (n = 874), and thoracic (n = 33) procedures. The most common procedure was SIPES appendectomy, and a unique prospective controlled trial supports its safety and effectiveness. Technically demanding surgeries such as hepatojejunostomy and colonic surgeries were described. Multichannel ports and multiple ports, standard and articulated instruments, transparietal instruments, retraction sutures, and magnets were used. Operative times, length of stay, and complications similar to standard laparoscopic surgery were described. A low conversion rate (to a reduced port, standard laparoscopy and open procedures) was also mentioned. No comparable measure for pain and cosmesis assessment was used. Conclusions: A wide experience in SIPES and feasibility has already been described with good clinical outcomes and low rate of conversion. Appendectomy is the unique procedure in which SIPES has been demonstrated to be safe and effective. It is pending the execution of prospective controlled trials for other operations to demonstrate, with objective evidence, the real benefits of this less invasive approach.