Operative techniqueStealth surgery: subcutaneous endoscopic excision of benign lesions of the trunk and lower extremity
Section snippets
Background
Benign subcutaneous lesions of the trunk are typically excised through a skin incision positioned over the lesion. Removal of these masses is most often elective and performed to prevent infection, improve cosmesis, and/or for diagnosis. Surgical excision, although effective in achieving the aforementioned goals, may result in significant and unpredictable scarring.
In an effort to minimize or conceal scarring, incisions are often made in natural skin folds or creases. This cannot always be
Patients and methods
A retrospective chart review was conducted on four consecutive subcutaneous endoscopic procedures for benign subcutaneous lesions from November 2006 to October 2008 by a single pediatric general surgeon, under Stanford University School of Medicine (Stanford, Calif) institutional review board approval.
Patients presenting to the general pediatric surgery clinic with radiologically confirmed solitary, benign lesions were given the option to undergo the endoscopic subcutaneous approach vs open
Results
All procedures were successfully completed using the endoscopic subcutaneous approach without conversion to open excision. Mean operative time for the nonrobotic cases was 110 minutes (range, 105-120 minutes). Total operative time for the robotic case, not including platform setup and docking, was 4 hours. There were no intraoperative complications.
At follow-up, the patient with the right anterior chest wall inclusion cyst presented with a 1-cm seroma at the site of his cyst, which resolved
Discussion
Operative excision of benign lesions of the trunk is often necessary to eliminate infection risk, confirm a diagnosis, and/or to improve cosmesis. Although truncal and lower extremity lesions may be located in areas concealed by clothing, more revealing seasonal attire, for example, bathing suits, make even subtle scars conspicuous.
Surgical scars can have a lifelong impact on the self-esteem and socialization of patients, as has been previously shown with respect to head and neck scars [2], [9]
References (10)
- et al.
The hidden cost of skin scars: quality of life after skin scarring
J Plast Reconstr Aesthet Surg
(2008) Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations
J Pediatr Surg
(2009)- et al.
Endoscopic excision of benign forehead masses: a novel approach for pediatric general surgeons
J Pediatr Surg
(2006) - et al.
“Stealth surgery”: transaxillary subcutaneous endoscopic excision of benign neck lesions
J Pediatr Surg
(2008) - et al.
Transaxillary subcutaneous endoscopic release of the sternocleidomastoid muscle for treatment of persistent torticollis
J Pediatr Surg
(2008)
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Endoscopic resection of subcutaneous lipoma and tumor-like lesion of the foot
2016, FootCitation Excerpt :However, the remote resection requires large flap and extensive dissection especially if in case of en-bloc resection of the mass. This can increase the risk of neurovascular injury, hematoma formation and seeding of the tumor tissue along the track [1,2,6,7]. For the endoscopic resection of subcutaneous lipoma or tumor-like lesion of the foot, there is no concealed area except the toe webs and long distant resection is not practical.
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2015, European Urology, SupplementsCitation Excerpt :This allows a cross-trigonal procedure of reimplantation with good outcomes reported, although the procedure is challenging with limited working space in small bladders [43]. Stealth surgery refers to the emerging techniques that aim to complete complex procedures without leaving any visible evidence on the body surface, and it is performed with incisions in inconspicuous locations [44]. These techniques attempt to reduce or eliminate skin incisions in an effort to improve cosmesis and reduce convalescence [45].
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2020, Indian Journal of Otolaryngology and Head and Neck Surgery