Transumbilical laparoendoscopic single-site surgery with conventional instruments for choledochal cyst in children: early results of 86 cases

The aim of this study is to present our techniques and early results of transumbilical laparoendoscopic single-site surgery (TULESS) for childhood choledochal cyst (ChC). Medical records of all children undergoing TULESS for ChC at our center from September 2012 to December 2013 were reviewed. Our TULESS operations started with a Z-shaped umbilical skin incision and placement of three 3-5-mm ports at separate points in the same incision site. The Roux-en-Y loop was created extracorporeally through the umbilical incision. Excision of the ChC and hepaticointestinal anastomosis were performed using conventional laparoscopic instruments. Eighty-six patients were identified with a median age of 24.5 months. The ChC was successfully excised by TULESS in all cases. Hepaticojejunostomy was performed in 84 cases, versus hepaticoduodenostomy in 2 cases. Additional trocars were needed in just 1.2%. There was no conversion to open surgery. The median operative time was 195 minutes. No drain was used in 90.7% of cases. There was no anastomotic leakage. Mild umbilical infection was noted in 2.3%. The median postoperative hospital stay was 5 days. At follow-up of 4-18 months, 1 patient needed a redo surgery for anastomotic stenosis; all other patients were in good health. The postoperative cosmesis was excellent as all TULESS patients were virtually scarless. TULESS with conventional laparoscopic instruments for ChC in children is feasible, with excellent postoperative cosmesis. The early outcome is promising, and TULESS can be a viable option for scarless surgical management of childhood ChC at experienced centers.