Operative technique
Stealth surgery: subcutaneous endoscopic excision of benign lesions of the trunk and lower extremity

https://doi.org/10.1016/j.jpedsurg.2009.12.016Get rights and content

Abstract

Background

Benign subcutaneous lesions of the trunk are typically excised through overlying skin incisions, which can result in permanent, potentially disfiguring scars. We previously reported our experience with transaxillary subcutaneous endoscopic approach for removal of benign lesions of the neck. Here we report a similar approach for removing benign lesions of the trunk and lower extremity.

Methods

A retrospective review was conducted on 4 consecutive subcutaneous endoscopic procedures for benign truncal and lower extremity lesions from November 2006 to October 2008. The lesions included an anterior chest wall epidermal inclusion cyst, anterior midsternal dermoid cyst, left posterior chest wall giant lipoma, and a lipoma extending from the right gluteal crease onto the thigh. Outcome measures included need for conversion, cosmetic outcome, and complications.

Results

All procedures were successfully completed using the endoscopic approach without conversion to open excision. There were no intraoperative complications. Postoperative complications included a 1 cm seroma at cyst site, axillary port site wound infection, and punctate dermal thinning secondary to adherent dermoid cyst, all resolved by 2 weeks postoperatively. All wounds healed with excellent cosmetic result at 1-month follow-up.

Conclusions

A subcutaneous endoscopic approach can be applied effectively to a variety of benign lesions of the trunk and lower extremities with adequate exposure for dissection and resulting in a quick recovery. Truncal and lower extremity scarring is absent, with small scars well hidden in either the axilla or the buttock, respectively.

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]

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