title: Cholecystectomy using single-incision pediatric endosurgery: technique and initial experience in the first 25 cases.
abstract: BACKGROUND
  Laparoscopic cholecystectomy has become the standard, in most pediatric surgery centers. In the search for a less-invasive procedure, a single-incision laparoscopic approach has been reported in adults and very few children.
  
  
  OBJECTIVE
  The aim of this study was to present our initial experience of cholecystectomy, using single-incision pediatric endosurgery (SIPES), including the technique, the intraoperative challenges, and the outcome.
  
  
  METHODS
  All pediatric patients who underwent a SIPES cholecystectomy from March through September 2009 were prospectively evaluated.
  
  
  RESULTS
  Twenty-five children underwent a SIPES cholecystectomy. The most frequent indications were symptomatic cholelithiasis in 17 patients (68%) and biliary dyskinesia in 5 (20%). Five patients had sickle-cell anemia. The mean operative time was 73 minutes (range, 30-122). Median hospital stay was 1 day. In 17 patients (68%), a percutaneous 2-mm grasper was used to retract the gallbladder over the liver. No complications were noted, and no conversion to an open procedure was required. In 5 patients, additional trocars were added. On follow-up, 3 days to 2 months later, no complications were noted. No patients were readmitted, and there were no wound infections.
  
  
  CONCLUSIONS
  Cholecystectomy, when using the SIPES approach in children, is a safe, reasonable alternative to conventional laparoscopy, leaving an inconspicuous scar. Whether SIPES offers any further benefit to the patient, besides improved cosmesis, should be evaluated in future studies.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Alabama, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
authors.forename: Cecilia Puga
authors.initials: CP
authors.lastname: Nougues
authors.forename: Carroll M
authors.initials: CM
authors.lastname: Harmon
authors.forename: Erik N
authors.initials: EN
authors.lastname: Hansen
authors.forename: Keith E
authors.initials: KE
authors.lastname: Georgeson
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Muensterer
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications; D001657:Biliary Dyskinesia / Q000601:surgery; D001660:Biliary Tract Diseases / Q000209:etiology / Q000601:surgery*; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome