**9.3 SIPES splenectomy**

SIPES splenectomy gives a good access for retrieving large-sized spleen through the umbilicus, instead of Pfannenstiel-Kerr incision used in conventional laparoscopic splenectomy CLS. Our technique is to place the patient in supine position with left side tilted 30°. Open-access trans-umbilical single-incision of 1.5 cm is used for placement of SILS port, Covidien (Medtronic) 12–15 mm SILS ports. Pneumoperitoneum is created and maintained at a constant pressure of 10–12 mm Hg. We insert 3 mm extra port in left flank for splenic retraction. We use only straight regular instruments. Dissection is performed by sealing device (LigaSure) in four stages: division of spleno-colic ligament at lower pole, dissection of vascular hilum, division of short gastric vessels, and detachment of diaphragmatic ligaments. The spleen is placed in a plastic bag and retrieved after morcellation with Péan forceps.

Insertion of portless extra 3 mm port in the left upper quadrant is necessary for elevation of the spleen to facilitate dissection of the hilum [20]. There is some argument about the use of extra port that it contradicts the concept of SIPES.

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*Single-Incision Pediatric Endosurgery (SIPES) DOI: http://dx.doi.org/10.5772/intechopen.85305*

**9.4 SIPES inguinal herniorrhaphy**

**9.5 SIPES cystectomy/oopherectomy**

**9.6 SIPES fundoplication**

**9.8 Obesity and SIPES**

**Summary**

and operate as in conventional laparoscopy.

finished through the umbilical incision.

**9.7 SIPES-assisted Mitrofanoff appendicovesicostomy**

nique for obese, and it is used for sleeve gastrectomy.

• Many procedures have been done in our center

are easier to be performed

cation is difficulty in suturing.

extracorporeal sliding notes.

sion techniques [21, 22].

There are some options to replace this port by using tug-exposure or suture suspen-

Our technique for inguinal herniorrhaphy is percutaneous internal ring suturing (PIRS). The child is placed on supine position, and the surgeon stands on contralateral site of hernia. Laparoscopic camera is inserted through supra umbilical incision. Both sides of deep inguinal ring are explored. Stab wound is placed on the skin crease above deep inguinal ring. Epidural needle inserted in pre-peritoneal area with looped 4/0 nonabsorbable suture. In female the suture surrounds the sac entirely. In boy the needle enters the peritoneum adjacent to vas or vessels for exchange of the suture.

We are using bronchoscope with foreign body retrieval forceps to retrieve the cyst and deliver it from the wound in neonate. In older children we use SIPES port

We insert liver retractor directly through stab wound. The dissection is carried out as in conventional laparoscopy, and traction suture around the esophagus is taken out from the abdominal wall. We performed two cases with large hiatus hernia. Intracorporeal suturing is done by Endo Stitch device (**Figure 2**).

We ligate the base of appendix by extracorporeal sutures instead of endo-loop.

In the beginning adult surgeons were doing SILS cholecystectomy on patients with BMI less than 34. Later with improvement of instrumentations and development of disposable and reusable SILS trocars, SILS is now is recommended tech-

• We found out that appendectomy, cholecystectomy, splenectomy, cystectomy, oopherectomy, orchidectomy, Mitrofanoff, nephrectomy, herniorrhaphy, adhesiolysis, malrotation, and Morgagni hernia

• Sleeve gastrectomy and fundoplication are less frequently done in our center; the reason in fundopli-

• This difficulty in older age group could be overcome with Endo Stitch instrument or the use of

The urinary bladder filled to come near the umbilical wound. The operation

**Figure 2.** *Endo Stitch device.*

*Pediatric Surgery, Flowcharts and Clinical Algorithms*

be completed successfully and safely by SIPES.

**9.2 SIPES cholecystectomy**

need for endobag.

**9.3 SIPES splenectomy**

morcellation with Péan forceps.

through a 1.5 cm umbilical incision. Single-incision port Medtronic 5–12 mm is placed using the open technique. The mesoappendix is divided by diathermy or sealing device, endo-loops is applied to secure the base of the appendix, and the appendix is then divided and retrieved through the port. Interferences and collisions between surgical instruments are worse than they are when conventional laparoscopic appendectomy (CLA) is performed using three incisions; this may extend the MOT. However, even with these challenges, difficult appendectomy can

Cholecystectomy is one of the most popular SIPES procedures. Our technique is to place a SILS port Covidien© (Medtronic) 5–12 mm in 1.5 cm trans-umbilical incision by open access. Obtaining the critical view of safety to properly visualize the cystic duct and artery is perhaps of utmost importance. The author modified the placement of straight needle for gallbladder fundus traction by transabdominal suture which is introduced percutaneously by curved needle. Once the gallbladder is properly retracted, the cystic duct and artery are identified, double clipped, and divided. The gallbladder is then dissected off the liver bed with hook cautery, and when completely detached, it is extracted from the abdomen through 12 mm port. No

SIPES splenectomy gives a good access for retrieving large-sized spleen through the umbilicus, instead of Pfannenstiel-Kerr incision used in conventional laparoscopic splenectomy CLS. Our technique is to place the patient in supine position with left side tilted 30°. Open-access trans-umbilical single-incision of 1.5 cm is used for placement of SILS port, Covidien (Medtronic) 12–15 mm SILS ports. Pneumoperitoneum is created and maintained at a constant pressure of 10–12 mm Hg. We insert 3 mm extra port in left flank for splenic retraction. We use only straight regular instruments. Dissection is performed by sealing device (LigaSure) in four stages: division of spleno-colic ligament at lower pole, dissection of vascular hilum, division of short gastric vessels, and detachment of diaphragmatic ligaments. The spleen is placed in a plastic bag and retrieved after

Insertion of portless extra 3 mm port in the left upper quadrant is necessary for elevation of the spleen to facilitate dissection of the hilum [20]. There is some argu-

ment about the use of extra port that it contradicts the concept of SIPES.

**144**

**Figure 2.** *Endo Stitch device.* There are some options to replace this port by using tug-exposure or suture suspension techniques [21, 22].
