Single-port laparoscoic varicocelectomy induces minmal post-operative stress response in children

Abstract

Purpose: Single incision laparoscopic surgery has recently been described in children and regarded as an improved technology leading to less pain and better cosmetic outcome. Compared with the traditional three-port method, it is not known if the single-port method is less invasive. The aim of this study was thus to investigate the post-operative acute inflammatory response in order to evaluate surgical stress in the two approaches in children. Methods: A prospective, single blinded, case control study was carried out. Fourteen male patients who presented with unilateral varicocele were divided into two groups. Seven children underwent single-port laparoscopic procedure while the other seven children underwent three-port laparoscopic procedure. Pre-operative and post-operative blood samples were taken for the measurement of tumor necrosis factor-a (TNF-a) and interleukin 6 (IL-6) using ELISA. Demographics including the operation time, and complications were recorded. Data were analyzed using unpaired t-test and a p value of <0.05 was taken as statistically significant. Results: The mean age of our patients was 14.5 years (range, 12–19 years). There was no significant difference between the two groups in terms of operative time, nor was there any complication recorded. The change in serum TNF-a concentration between pre- and post-operatively was 0.324 0.406 pg=ml in the single-port group and 0.329 0.952 pg=ml in the three-port group (p¼0.990). For serum IL-6, the change in pre-operative and postoperative levels was 0.151 0.392 pg=ml and 0.097 0.929 pg=ml (p¼0.899) for the single-port group and three-port group respectively. Conclusions: Single-port laparoscopic varicocelectomy is safe, effective and produces better cosmesis and minimal surgical stress.