title: A microlaparoscopically assisted pull-through procedure for Hirschsprung's disease: initial experiences.
abstract: OBJECTIVE
  The purpose of this prospective study was to evaluate the efficiency, feasibility, and surgical outcomes of microlaparoscopy-assisted pull-through (MAPT) for Hirschsprung's disease.
  
  
  METHODS
  Starting in 2005, pull-through procedures for Hirschsprung's disease were performed exclusively using 2-mm instruments and miniscopes (microlaparoscopy). Three miniports were inserted laterally in the right abdominal wall in one line, with the miniscope at the level of the umbilicus and the working trocars cranially/caudally of the scope. The left colon was dissected, and transanal pull-through was performed.
  
  
  RESULTS
  MAPT was performed in 16 children (10 boys and 6 girls; average age: 5.7 months). Six patients had previous abdominal surgeries. A 1.9-mm cystoscope or a 2.4-mm arthroscope was used in the first 5 cases. In the remainder, a recently developed 2.4-mm miniscope was used for visualization. The length of the resected colon segment was up to the left colonic flexur in 5 children, up to the middle of the descending colon in 4 cases and up to the sigmoid-descending segment in 7 children. The average operation time was 185 minutes (range: 120-330 minutes). The only intraoperative complication that occurred was an injury of the right iliac vein by inadvertent slippage of an electrocautery hook requiring laparotomy. At follow-up, 80% of the parents were unable to identify the scars after microlaparoscopy.
  
  
  CONCLUSIONS
  MAPT is a safe and practical procedure regardless of age or previous surgery.
authors.affiliation: Department of Pediatric Surgery, University Medical Center, Mainz, Germany. salmai.turial@unimedizin-mainz.de
authors.forename: Salmai
authors.initials: S
authors.lastname: Turial
authors.forename: Jan
authors.initials: J
authors.lastname: Enders
authors.forename: Veronika
authors.initials: V
authors.lastname: Engel
authors.forename: Tamer Ali
authors.initials: TA
authors.lastname: Sultan
authors.forename: Felix
authors.initials: F
authors.lastname: Schier
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011446:Prospective Studies