A Novel Nonelectrosurgical Technique for Incising the Pylorus in Laparoscopic Pyloromyotomy

Objective: Since the loss of the protected arthrotomy knife several years ago, pediatric surgeons have struggled to find a safe, reliable, and inexpensive way to incise the pyloric serosa before spreading the muscle. The most widely accepted method of cutting the serosa is with electrocautery, although some still question its safety. We introduce a novel technique of incising the serosa with a percutaneously inserted needle without the use of electrocautery. Description: In this case series, we describe the experience of a single surgeon with a novel technique of incising the serosa. A retrospective chart review was conducted between January 2012 and September of 2015. In 6 patients, the serosal incision on the pylorus was made using a percutaneously inserted 18 gauge needle to cut the serosa and the superficial hypertrophied muscle fibers. As the body of the needle is not sharp, it protects the mucosa from being lacerated as the incision is carried out given a fixed depth of cut. Results: The last 6 patients with hypertrophic pyloric stenosis underwent this technique. There were no conversions to open. In addition, there were no perforations and no complications related to the alteration in technique. Conclusions: Although many manufacturers pursue both disposable and nondisposable solutions to this problem, we believe this is a safe, reliable, and very inexpensive solution to this simple problem.