title: Pediatric varicocelectomy: a comparative study of conventional laparoscopic and laparoendoscopic single-site approaches.
abstract: OBJECTIVE
  Laparoscopy is a common approach to manage varicoceles in both the adult and pediatric population. The purpose of this study is to report our experience and compare outcomes between conventional laparoscopy and laparoendoscopic single-site (LESS) surgery for varicocelectomy in the pediatric population.
  
  
  METHODS
  A retrospective cohort study was performed of all patients who underwent conventional laparoscopic varicocelectomy (LV) and laparoendoscopic single-site varicocelectomy (LESSV) at a single pediatric institution from December 2007 to March 2012. Patient demographics, intraoperative details, narcotic use, and complications were reviewed.
  
  
  RESULTS
  LV was performed in 32 patients and LESSV in 11 patients. None had conversion to open surgery. Median age was 16 years for LV (range 12-23) and 15 years for LESSV (range 12-20), P=0.061. Median operative time was 55 minutes for LV (range 28-90) and 46 minutes for LESSV (range 33-59), P=0.037. Nine (81.8%) patients in the LESSV group and 10 (31.2%) patients in the LV group were administered narcotics in the recovery room, P=0.005. One (3.1%) patient in the LV group was administered ketorolac in the recovery room, P=1. Five patients in each group, LESSV (45.5%) and LV (15.6%), received acetaminophen in the recovery room, P=0.092. All procedures were performed on an outpatient basis except for one because of a concomitant procedure. Median follow-up was 22 months in LV and 15 months in LESSV, P=0.015. One (3.1%) postoperative hydrocele was noted after LV and 1 (9.1%) after LESSV, P=0.451. All varicoceles were clinically resolved in both groups.
  
  
  CONCLUSIONS
  LESSV is comparable to LV in the pediatric population. Our initial experience indicates that the LESS approach may be more painful in the immediate postoperative period than conventional laparoscopy. The LESS technique warrants further evaluation to determine if one approach is clearly more advantageous.
authors.affiliation: Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: Danesh
authors.initials: D
authors.lastname: Bansal
authors.forename: Edward
authors.initials: E
authors.lastname: Riachy
authors.forename: W Robert
authors.initials: WR
authors.lastname: Defoor
authors.forename: Pramod P
authors.initials: PP
authors.lastname: Reddy
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Minevich
authors.forename: Shumyle
authors.initials: S
authors.lastname: Alam
authors.forename: Paul H
authors.initials: PH
authors.lastname: Noh
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001706:Biopsy / Q000009:adverse effects; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D006848:Testicular Hydrocele / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D014646:Varicocele / Q000150:complications / Q000601:surgery*; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D020910:Ketorolac