The Percutaneous ‘Pick and Fix’ Suture: A Surrogate Port for Paediatric Laparoscopic Procedures

Research Article

Austin J Gastroenterol. 2015;2(4): 1045.

The Percutaneous ‘Pick and Fix’ Suture: A Surrogate Port for Paediatric Laparoscopic Procedures

Bajpai M* and Mitra A

Department of Paediatric Surgery, All India Institute of Medical Sciences, India

*Corresponding author: Bajpai M, Department of Paediatric Surgery, All India Institute of Medical Sciences, India

Received: February 11, 2015; Accepted: March 24,2015; Published: March 27, 2015

Abstract

Objective: To apply and expand the utility of the traditional percutaneously placed stay suture during laparoscopy.

Materials and Methods: Children undergoing laparoscopic surgery from the period, December 2012 to November 2013 were included in this study. The use of the percutaneously stay suture (‘pick and fix’) in facilitating surgery was studied. The ease of placement, enhanced visualization as noted by the operating surgeon, total number of ports placed during surgery, total number of sutures placed and per-operative complications were all noted. Procedure related morbidity and eventual patient/care-giver satisfaction with cosmetic outcome were also noted.

Results: 58 children underwent laparoscopic procedures during the aforementioned duration and included nephroureterectomies visualization and decrease the total number of ports across the variety of procedures to which it was applied. Cosmetic results were satisfactory.

Conclusion: The versatility of this technique allows its application to various laparoscopic procedures. It enhances the minimally invasive nature of laparoscopy itself and may, thus, act as a substitute for conventional ports, the ultimate result being good cosmetic outcomes and patient satisfaction.

Keywords: Less; Paediatric laparoscopy; Percutaneous hitch stitch; Cholecystectomy; Appendicectomy; Lumboscopy

Introduction

The advent of Minimal Access Surgery (MAS) has given rise to a plethora of applications in paediatric surgery. The emerging techniques in MAS include multiport/single-incision procedures, Natural Orifice Transluminal Endoscopic Surgery (NOTES) and more recently single-port/single-incision procedures. The evolution of modes of access reflects the desire to cause minimal trauma to the patient [1]. There is a need [2] to introduce techniques such as percutaneous retraction sutures and modifications of the standard laparoscopes to minimize instrumentation.

Patients and Methods

Children undergoing laparoscopic surgery from the period, December 2012 to November 2013 and operated by the senior author (MB) were included in this study. Standard operating techniques were used while giving primacy to the safety of the procedure. The use of the percutaneous hitch suture in facilitating surgery was studied. The ease of placement, enhanced visualization as noted by the operating surgeon, total number of ports placed during surgery, total number of sutures placed and per-operative complications were noted. Procedure related morbidity and eventual patient/care-giver satisfaction with cosmetic outcomes were also observed.

The procedures carried out in this time frame can be broadly divided into:

The Approach

Laparoscopy: The operative laparoscope (Figure 1) (the 0°, all in one laparoscope with parallel eyepiece) necessitates the insertion of a 12 mm port. Our standard approach is intra-umbilical insertion i.e. through the umbilical cicatrix, with meticulous reconstruction at the time of port closure for maximum aesthetic benefit. The 6 mm working channel of this “co-axial” scope allows one to dispense with one of the additional 5 mm ports.