MP66-12 PERCUTANEOUS EXTERNALLY ASSEMBLED LAPAROSCOPIC INSTRUMENTS FOR FOWLER-STEPHENS ORCHIOPEXY: THE FEASIBILITY OF A NEW SURGICAL SYSTEM

You have accessJournal of UrologyPediatrics: Testis, Varicocele & Stones1 Apr 2017MP66-12 PERCUTANEOUS EXTERNALLY ASSEMBLED LAPAROSCOPIC INSTRUMENTS FOR FOWLER-STEPHENS ORCHIOPEXY: THE FEASIBILITY OF A NEW SURGICAL SYSTEM Isaac Kelly, Samuel Abourbih, Minh Chau, Nazih Khater, Mohamed Keheila, Salim Cheriyan, Patrick Yang, Jim Shen, Matthew Pierce, and D. Duane Baldwin Isaac KellyIsaac Kelly More articles by this author , Samuel AbourbihSamuel Abourbih More articles by this author , Minh ChauMinh Chau More articles by this author , Nazih KhaterNazih Khater More articles by this author , Mohamed KeheilaMohamed Keheila More articles by this author , Salim CheriyanSalim Cheriyan More articles by this author , Patrick YangPatrick Yang More articles by this author , Jim ShenJim Shen More articles by this author , Matthew PierceMatthew Pierce More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2027AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conventional laparoscopy is routinely used for the evaluation and management of the non-palpable testis but routinely requires three 5 mm ports that result in 9-10 mm scars. We have developed novel percutaneous externally assembled laparoscopic (PEAL) instruments which allow for nearly scarless laparoscopy. We present here a clinical series of six pediatric patients who underwent a Fowler-Stephens orchiopexy using these instruments. METHODS Using the PEAL instruments, one patient underwent a single stage, four patients underwent a first stage and one patient underwent a second stage Fowler-Stephens orchiopexy. In all cases, a 5 mm port was placed at the umbilicus for the camera. The PEAL instrument, which consists of a reusable handle and a 2.96 mm shaft was then introduced lateral to the rectus sheath at the level of the umbilicus using a special introducer tip under direct visualization. The introducer was then brought out through the camera port and switched to a 5 mm grasper tip. An additional 5 mm port was placed on the right at the same level for insertion of a hook electrode and clip applier. RESULTS The PEAL instruments functioned well for all dissection and grasping tasks, similar to 5 mm conventional instruments. Using these innovative new instruments, all patients underwent successful Fowler-Stephens procedures. Median operative time was 66 minutes (45-180 minutes). Blood loss was less then 5 mL in all cases. All six patients were discharged the day of surgery. The procedures were well tolerated without any perioperative or postoperative complications. At follow up, the average length of the PEAL scars was 3.25 mm, while the 5 mm port scars were 10 mm. CONCLUSIONS We describe a novel instrument paradigm for performing a pediatric laparoscopic Fowler-Stephens orchiopexy. These instruments offer improved cosmesis compared to conventional laparoscopy, and may show promise in other laparoscopic applications. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e866 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Isaac Kelly More articles by this author Samuel Abourbih More articles by this author Minh Chau More articles by this author Nazih Khater More articles by this author Mohamed Keheila More articles by this author Salim Cheriyan More articles by this author Patrick Yang More articles by this author Jim Shen More articles by this author Matthew Pierce More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...