title: Single instrument intracorporeal knot tying during single port laparoscopic hernia repair in children: a new simplified technique.
abstract: BACKGROUND
  With the increasing number of open surgical procedures shifting to laparoscopy, laparoscopic suturing and knot tying are becoming integral parts of the skills that any laparoscopist must acquire. It is the most difficult step in laparoscopic surgery, especially in single incision pediatric endosurgery (SIPES). It needs special laparoscopic skills and very long learning curve. The aim of this study is to introduce a new simplified technique for single instrument intracorporeal suture tying during single incision laparoscopic hernia repair (SILHR).
  
  
  METHODS
  This study was conducted at Al-Azhar University Hospitals between June 2008 and June 2010. Three-hundred and eighty three patients with 402 congenital inguinal hernias were subjected to SILHR using percutaneous insertion of purse string suture by Reverdin Needle (RN) with single instrument intracorporeal suture knot tie.
  Under general endotracheal tube anesthesia, a 0.8-1.2-cm. longitudinal transumilical skin incision was done for insertion of the umbilical port and a 3-mm Maryland forceps. RN was used for insertion of a purse string suture with single instrument intracorporeal suture tie around internal inguinal ring (IIR). The purse-string knot airtightness was stress-tested by raising the intraperitoneal CO2 pressure to 16-24mm Hg for about 30seconds.
  
  
  RESULTS
  A total of 383 patients with 402 congenital inguinal hernias were subjected to SILHR. They were 304 males and 79 females with a mean age of 2.2±2.25years. A single instrument technique was used for intracorporeal suture knot tie and all cases were completed laparoscopically without conversion. The mean operative time was 12.5±3.3minutes for unilateral hernia repair and 17±4.37 for bilateral cases. All patients achieved full recovery without intraoperative or postoperative complications.
  
  
  CONCLUSIONS
  Single instrument intracorporeal suture tie is feasible, simple, and rapid as it resulted in marked decrease of operative time. It is of low cost, secure and gives great help during SIPES surgery without struggling. It is a good alternative option to extra corporeal knot tying.
authors.affiliation: Pediatric Surgery Department, Al-Azhar University, Cairo, Egypt.
authors.forename: Magid
authors.initials: M
authors.lastname: Ismail
authors.affiliation: Pediatric Surgery Department, Al-Azhar University, Cairo, Egypt. Electronic address: rafikshalaby@hotmail.com.
authors.forename: Rafik
authors.initials: R
authors.lastname: Shalaby
mesh_terms: D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007264:Inguinal Canal / Q000601:surgery; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures
keywords: Intracorporeal; Laparoscopy; Single incision laparoscopic surgery; Single instrument; Suture knot tie