Hidden Incision Endoscopic Surgery: Description of Technique, Parental Satisfaction and Applications

Purpose: The advantages of minimally invasive surgery over open surgery in pediatrics include smaller incisions, decreased postoperative pain, reduced postoperative narcotic use, faster return to normal activity and decreased length of hospitalization. However, minimally invasive surgery with its traditional port placement leads to visible scars. To eliminate scarring, we have developed HIdES(SM), or hidden incision endoscopic surgery. Materials and Methods: For this technique a robotic working port, camera port and 5 mm assistant port are placed below the line of a Pfannenstiel incision. The second working 8 or 5 mm port is placed infraumbilically. The procedure is then carried out depending on the nature of the case. For this study operative times were recorded. Patients who underwent HIdES pyeloplasty or nephrectomy and their parents were asked to compare the cosmetic outcome of the trocar incisions to pictures of patients who had undergone laparoscopic surgery (pyeloplasty or nephrectomy) with traditional port placement and open surgery using validated wound and scar evaluation scales. Results: HIdES was used in 12 cases. No complications were encountered. When comparing all 3 questionnaire results for each technique used, parents and patients were statistically more satisfied with the cosmetic results after HIdES than traditional laparoscopic or open operation. Conclusions: The HIdES technique allows all port sites to be hidden at the level of a Pfannenstiel incision, and thus renders them nonvisible if the patient is wearing a bathing suit. This approach is preferred by patients and parents alike.