**5. Public opinion**

Which technique the public choose if NOTES and SIPES were the only options offered to them? [14]

**141**

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

• 208 (20.7%) choose NOTES

• 3 (0.3%) would refuse surgery

1006 individuals completed the questionnaire explained by F1 medical intern, so as not to bias anyone. All individuals were from around London. 458 (45.5%) were males and 548 (54.5%) were females. 129 were < 20 yrs. old, 460 were

20–29 yrs. old, 186 were 30–39 yrs. old, 103 were 40–49 yrs. old, 61 were 50–59 yrs. old, and 67 were ≥ 60 yrs. old. 80 were physician, 88 medical students, 39 were nurses, and 6 were NHS admin [15]. 793 were nonmedical. Taking the choices by gender, profession, and age, the preference order for the four approaches was:

The position of SIPES port may be different depending on many factors like choice of surgeon, type of surgery, and the age of the patient. The different loca-

• The disadvantages are balanced with the patient satisfaction and excellent cosmetic results.

The author prefers trans-umbilical incision as its ideal to prevent any visible scar, easy access, and quick closure with no port site hernia. In pediatric it gives

There are many types of ports with different sizes in the market. The devices are either disposable or reusable: SILS device by Covidien© (Medtronic), GelPOINT system by Applied Medical, R-Port and TriPort by Advanced Surgical Concepts,

1.Omega-shaped incision made around the upper half of umbilicus.

3.Incisions are also given above and below umbilicus.

• SIPES is safe and feasible technique for pediatric age group.

4.Incision maybe placed in the pubic hairline medially.

• 795 (79.0%) choose SILS

• 1st—SILS

• 3rd—NOTES

• 4th—open

**Summary**

**6. Port position**

**7. Types of ports**

tions commonly used are:

2.Trans-umbilical incision.

opportunity to repair the umbilical hernia.

• 2nd—conventional lap

Most people choose SILS over NOTES when asked about this scenario.

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


1006 individuals completed the questionnaire explained by F1 medical intern, so as not to bias anyone. All individuals were from around London. 458 (45.5%) were males and 548 (54.5%) were females. 129 were < 20 yrs. old, 460 were 20–29 yrs. old, 186 were 30–39 yrs. old, 103 were 40–49 yrs. old, 61 were 50–59 yrs. old, and 67 were ≥ 60 yrs. old. 80 were physician, 88 medical students, 39 were nurses, and 6 were NHS admin [15]. 793 were nonmedical. Taking the choices by gender, profession, and age, the preference order for the four approaches was:

• 1st—SILS

*Pediatric Surgery, Flowcharts and Clinical Algorithms*

**2. Limitations of SIPES**

pediatric SIPES [7–13].

**3. Advantage of SIPES**

**4. Disadvantage of SIPES**

**5. Public opinion**

offered to them? [14]

appeared in 1992 with appendectomies [4]. In the same year, D'Alessio described a technique for appendectomy in pediatric patients in which a special port was used at the umbilicus to allow the surgeon to bring the appendix out through the umbilicus to perform an extracorporeal appendectomy [5]. 19% of 166 patients in their series required additional trocars, and 4% required conversion to an open operation. The MOT (MOT) was 35 min with a 7-day return to normal activity, compared with 10 days for those that required additional trocars. SIPES has been introduced in our institute by 2003. Now SIPES is our standard technique for many procedures like cholecystectomy, splenectomy, appendectomy, assisted Mitrofanoff, SIPES hernia repair percutaneous internal ring suturing (PIRS), ovarian cystectomy, and fundoplication since 2011. We have performed around 400 SIPES cases up-to-date.

SIPES is not a new technique. It is actually a modification of current laparoscopic technique with some modified instruments and approach used successfully for multiple laparoscopic procedures. Almost all cases which could be done by conventional laparoscopy are amenable to be done by SIPES like splenectomy, appendectomy, cholecystectomy, colectomy, anterior resection, hernia repair, splenectomy, Nissen fundoplication, and sleeve gastrectomy. The approach failed to gain momentum for several years, due to technical limitations with conventional instrumentation. These limitations did not prevent surgeons from using SIPES in pediatric age group. Barbaros and Dinccag [6] published the first two adult cases of SILS splenectomy in 2009. Later Dutta reported the first SIPES splenectomy in 2012 [7]. Recently still few centers worldwide have advanced

Fewer incisions, cosmesis, and non-violation of natural orifices are the most attractive reasons for the patient to choose SILS technique; as a surgeon, ease of tissue retrieval and combination procedures are the main reasons. Using standard laparoscopic equipment has facilitate the procedure for the surgeon with less cost.

In comparison with CLS, increased postoperative pain and violation of ergonomic principles in SIPES were not proven in the published studies. Hernia might be a problem in adults published series, but we did not encounter any in our patients. In reverse SIPES, it is an opportunity to repair the umbilical hernia when closing the wound in pediatric age group. Wound infection was not different from conventional laparoscopy. Learning curve escalates fast, and the cost-effectiveness

Which technique the public choose if NOTES and SIPES were the only options

Most people choose SILS over NOTES when asked about this scenario.

was proven to be less costly than conventional laparoscopy [3].

**140**


#### **Summary**

