A Clinical Evaluation of the Use of Radially Expandable Laparoscopic Access Devices in the Pediatric Population

Abstract

ABSTRACT

The methods used to obtain laparoscopic and thoracoscopic access are associated with complications ranging from cannula slippage to visceral and major vascular injuries. This study evaluates the use of a radially expandable access device in pediatric minimally invasive surgery with a focus on the incidence of major and minor cannula-related complications. From 1994 to 1999, 2,157 patients at seven institutions underwent minimally invasive procedures using a radially expandable access device (Step^TM). Their ages ranged from 1 day to 21 years (mean 7.2 years). The number of devices used per case ranged from one to seven (mean 3.3). Access was obtained using a Veress needle inserted into a radially expandable sleeve, followed by dilatation with a 3-mm, 5-mm, 7-mm, or 12-mm diameter cannula. Factors monitored included abdominal wall bleeding, vascular and visceral injuries, cannula slippage, and loss of pneumoperitoneum. A total of 7,117 cannulas were inserted. There were no major vascular or visceral injuries (0/1,000). Cannula slippage occurred in 19 cases (8.8/1,000), with subsequent loss of pneumoperitoneum occurring in 4 cases (1.9/1,000). There were only 3 cases of abdominal wall bleeding (1.4/1,000). Only one incisional hernia occurred (0.46/1,000), despite the fact that 83% of the fascial defects were left open. In comparison with the literature, the incidence of injury in this series was significantly reduced (p < 0.00001). The Step^TM radially expandable access device is safe and effective for laparoscopic and thoracoscopic procedures in children of all ages, including small neonates. This device significantly reduces the risk of entry-related injuries and minimizes the inconveniences of cannula slippage and loss of pneumoperitoneum.