Instead, many pediatric surgeons often prefer to place several Rucaparib supplier 3�C5mm ports through a single umbilical wound, (Figure 1) as well as transabdominal sutures. These sutures are used to encircle the round ligament for liver retraction and often include seromuscular bites through the wall of various hollow organs including the gallbladder, stomach, or mesoappendix [2, 10, 11]. These ��retracting�� stitches are a common practice among pediatric surgeons and are particularly useful in small children due to their thin abdominal wall (Figure 2). Figure 2 Multitrocar port inserted for single-incision laparoscopic cholecystectomy. An extralong endoscope and two instruments with different lengths were used to avoid hand clashing.

An acceptable technique for retraction consists in the placement of thin graspers through remote stab incisions or through the same fascial opening [11]. 4. Single-Incision Laparoscopic Appendectomy Two techniques of SIL appendectomy are currently available as follows. 4.1. Intracorporeal SIL Appendectomy Intracorporeal SIL appendectomy is commonly performed with the three-trocar technique. Two 5mm and one 3mm low-profile trocars are introduced through separate fascial openings after a curvilinear infraumbilical incision is made in the skin. The trocars are generally positioned at 2, 6, and 10o’clock position. An angled 30�� camera is introduced through one of the 5mm ports and its tip kept close to the abdominal wall to avoid clashing with the working instruments. The appendix is retracted with a grasper and the mesoappendix followed to its base where it is divided with hook cautery.

The appendix is then double ligated with endoloops, divided with scissors, and retrieved using one of the three following techniques: (1) direct removal through the umbilicus, (2) inserting the finger of a surgical glove and placing the specimen within this for retrieval, or (3) use of conventional endoscopic retrieval bag inserted alongside the camera and grasping instrument. To facilitate removal, the three small incisions are connected into one, and the wound closed in layers. 4.2. Extracorporeal SIL Appendectomy In this technique, a single 10mm trocar is inserted through the umbilicus with a semiopen technique. A blunt grasper is introduced through the single channel of an operating laparoscope to mobilize the appendix from inflammatory adhesions until the mesoappendix is exposed.

It is then grabbed, gently pulled inside the trocar, and removed simultaneously with the scope. Once exteriorized, the appendix is ligated Anacetrapib and divided outside the abdomen with a standard technique. The appendiceal stump is then returned to the peritoneal cavity and the incision closed. 5. Single-Incision Laparoscopic Cholecystectomy SIL cholecystectomy (SILC) is one of the most popular procedures in both adults and children.