title: Is single incision pediatric endoscopic surgery more painful than standard laparoscopy in children? Personal experience and review of the literature.
abstract: OBJECTIVE
  It has been speculated that single incision pediatric endoscopic surgery (SIPES) in children could result in more postoperative pain given the device size for a child umbilicus. Herein, we compare the postoperative pain in children who underwent SIPES or standard laparoscopy (SL).
  
  
  METHODS
  Patients who underwent SIPES via Olympus TriPort™ Access system between 2010 and 2011 were prospectively compared with SL controls (similar age, sex and type of operation). Primary endpoint was analgesic requirement (number of doses and dose/kg). A systematic review of the literature included all articles (2008-2012) comparing postoperative pain following transumbilical SIPES and SL in children. Data were analyzed using non-parametric tests.
  
  
  RESULTS
  Ten patients (8 males, median age 9 years, range 4-15) underwent 11 SIPES procedures: appendicectomy (N.=6), orchidopexy (N.=2), cholecystectomy (N.=2), and total colectomy (N.=1). There was no difference in paracetamol requirement between SIPES (median 74 mg/kg, range 14-149) and SL (median 59 mg/kg, range 13-108, P=0.76) patients. Morphine was required by only two patients per group (no difference in dosage or frequency). Eight studies (2010-2012) comparing 334 SIPES vs. 343 SL patients were analysed. Three studies showed advantage of SIPES, and four no difference between SIPES and SL. One randomized trial reported greater pain in SIPES appendicectomy, but no difference with SL once patients were discharged home.
  
  
  CONCLUSIONS
  SIPES does not seem to be associated with more postoperative pain than SL in children. In appropriate cases, SIPES is a valid alternative to SL for a good range of pediatric procedures.
authors.affiliation: Department of Pediatric Surgery, King's College Hospital, London, UK - augustozani@yahoo.it.
authors.forename: A
authors.initials: A
authors.lastname: Zani
authors.forename: N
authors.initials: N
authors.lastname: Ade-Ajayi
authors.forename: L A
authors.initials: LA
authors.lastname: Cancelliere
authors.forename: K I
authors.initials: KI
authors.lastname: Kemal
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.forename: A P
authors.initials: AP
authors.lastname: Desai
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001062:Appendectomy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000379:methods; D003082:Colectomy / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D056126:Orchiopexy / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology*; D011446:Prospective Studies; D014472:Umbilicus
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine