The "diamond port configuration": a standardised laparoscopic technique for adolescent intestinal resection and anastomosis

• Published in: African journal of paediatric surgery Vol. 9; no. 1; pp. 57 - 61
• Main Authors: Hill, Richard, Ade-Ajayi, Niyi, Desai, Ashish, Nunoo-Mensah, Joseph
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2012; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Adolescent; Analysis; Anastomosis; Anastomosis, Surgical; Children & youth; Clinical Competence; Clinical Protocols; Digestive System Surgical Procedures - methods; Female; Gastrointestinal surgery; Humans; Inflammatory bowel disease; Intestinal Diseases - surgery; Intestine, Large; Intestines - surgery; laparoscopic colorectal surgery; Laparoscopic surgery; Laparoscopy; Laparoscopy - methods; Learning Curve; Learning curves; Male; Medical protocols; Methods; Patient Care Team; Pediatrics; Perioperative Care; standardisation; Study and teaching; Surgery; Surgical anastomosis
• ISSN: 0189-6725; 0974-5998
• DOI: 10.4103/0189-6725.93309

Familiarity with technique and repetition enhance efficiency during laparoscopic surgery. This is particularly important when undertaking complex bowel resections. We report a standardised protocol that includes theatre layout, patient position and port insertion, which we believe facilitates excellent abdominal access and ergonomics and has the potential to shorten the duration of the team-learning curve. A strategic unit development plan led to the commencement of a laparoscopic service for adolescents with bowel disorders. A standardised protocol for intestinal resections was agreed upon at a monthly Paediatric Minimal Access Group meeting. This covered patient position, port insertion, technical aspects of intestinal resection and perioperative management. In particular, a diamond configuration for ports was agreed upon. Data were prospectively collected, and included patient demographics, operative times, conversion rates and postoperative outcomes. Unless otherwise indicated, data are presented as medians with ranges. Seven procedures were carried out in six patients (three female) aged 14 (11-14) years. Access to the entire abdominal cavity, vision and ergonomics were excellent in all. There were no conversions to open surgery. In all procedures, the technique was considered safe and effective. The length of hospital stay was 6.5 (5.8-14) days. A standardised protocol including the use of the diamond port configuration has several putative advantages for laparoscopic bowel resections and anastomoses. These include efficiency, reproducibility, predictability, good visibility and excellent ergonomics. We recommend this approach as a means to shorten the procedure-specific learning curve of the laparoscopic team.