P1. Single port treatment of epigastric hernias with the use of a pleuroscope

María José Rosell Echevarría, Raquel Angélica Hernández Rodríguez; Eduardo Luis Pérez-Etchepare Figueroa; Mario Alberto Gómez Culebras. Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain

Epigastric hernias have a 4% prevalence in pediatric population. The traditional repair involves a transverse incision, disection and simple individual stiches, leaving visible scars. The use of a minimally invasive single port technique using a pleuroscope has multiple advantages, being a safe and feasible technique even for surgeons in training while maintaining an excellent cosmetic result. 

P2. More than 500 procedures performed with a 5mm, 3.5mm working channel pleuroscope that allowed even less invasive surgery

Raquel Angélica Hernández Rodríguez, María José Rosell Echevarría, Eduardo Luis Pérez-Etchepare Figueroa, Mario Alberto Gómez Culebras. Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain

Single port endoscopic surgery using a 5mm scope with a 3.5mm working channel can be a feasible alternative for achieving even less invasiveness in Pediatric Surgery, from inguinal hernia and gastrostomies to sympathectomies.

P3. Laryngotracheo-oesophageal cleft masquerading as a secondary megaoesophagus with concurrent foregut duplication: Discussion and demonstration of interesting endoscopic findings

Bhushanrao Jadhav, Aruna Abhyankar, Jim Stewart, Semiu Eniola Folaranmi. Noah's Ark Children's Hospital, University Hospital of Wales, Cardiff, Wales

The Laryngotracheo-oesophageal cleft and the duplication cysts of foregut are rare. We demonstrate a case of a neonate having both the anomalies with interesting endoscopic findings. LTE type 4 is an extremely rare and difficult diagnosis needing a high index of suspicion and thorough endoscopic evaluation.

P4. Retained rectal Pouch: Diagnosis and Management

Bhushanrao Jadhav, Aruna Abhyankar, Anthony Lander, Indre Zaparackaite. Noah's Ark Children's Hospital, University Hospital of Wales, Cardiff, Wales

We are reporting a case of male child with anorectal malformation with a rectourethral fistula who required a resection of rectal pouch that was left behind after the original laparoscopy assisted anorectoplasty. The laparoscopic assistance proved vital to achieve a safe and complete dissection of rectal pouch as well as preservation of vas deferens and seminal vesicles. Per urethral Mucous discharge post Lap assisted anorectoplasty / PSARP is an alarming symptom. Micturating cystourethrogram and cystourethroscopy is a key to diagnosis. Complete Laparoscopic approach is safe and feasible for excision of retained rectal pouch.  

P5. Laparoscopic splenopexy without mesh: an alternative management for wandering spleen. 

Jonathan Ducey, David J Wilkinson, Robert T Peters, Nick Lansdale. Royal Manchester Children's Hospital, Manchester, UK

A 4-year-old boy presented with a 3 month history of intermittent abdominal pain and imaging confirmed the diagnosis of a wandering spleen. A laparoscopic splenopexy was performed. The spleen was placed within a fashioned pre-peritoneal pocket and the peritoneum closed with 2-0 Ti-Cron sutures, leaving a defect accommodating the splenic hilum. To avoid internal herniation, the splenic flexure of the colon was mobilised and the colon moved caudally. Follow-up with serial ultrasonography has shown good splenic perfusion and healthy architecture.
Given ongoing concerns about the long-term effects of non-biological mesh prostheses, we demonstrate that laparoscopic splenopexy with a pre-peritoneal pocket is a safe operative strategy.

P6. Minimally Invasive Primary Percutaneous Endoscopic Jejunostomy using T-Fastner technique in small children: a single center experience. 

Sofia Chacon, Joshua Cave, Amulya Saxena, Muhammmad Choudhry, Simon Clarke. Chelsea and Westminster Hospital, London, UK

We present the evaluation of feasibility and study of short-term outcomes of primary PEG-J  insertion using T-fastener technique in small children. Primary PEGJ is considered a technical challenge in  low weight children, hence, avoided. In our centre primary PEGJ tubes are inserted using a KC-T-fastener technique. We looked over a 17 patients over a 4 years period and described success utilising minimally invasive techniques evaluated across patients and complication rates in <10kg and >10kg patients compared to evaluate if small infants at higher risk of complications. To conclude that

• Primary PEGJ is feasible in small infants and does not result in significantly more complications in the smallest children

• The KC- T fastener technique is a safe and easy to learn procedure that avoids delays associated with converting from a primary gastrostomy

P7. Case Report; Double Ureteric Obstruction Mimicking Bowel Obstruction 

Shimaa Ibrahim, Anu Paul, Pankaj Mishra, Massimo Garriboli, Arash Taghizadeh. Evelina Children’s Hospital, London, UK

P8. Scopes for small babies. A reversible, single stage, minimally invasive, instant solution; the primary laparo-endoscopic gastro-jejunal tube with gastropexy. 

Harmit Ghattaura, Alex Lee. Oxford University Hospitals, Oxford, UK

We demonstrate a feasible minimally invasive surgical technique for the insertion of a primary gastrojejunal tube. This technique can be performed in children with a median weight of 6kg providing a safe instant method of jejunal feeding. Subsequent changes are made within our radiology department’s fluoroscopy suite. Children can also trial gastric feeding whilst the tube remains in situ.

P9 Use of Lymphangiography in Neonates Prior to Thoracic Duct Ligation: a report of two cases and review of the literature. 

Jonathan J Neville, Carmen S Chacon, Simon Jordan, Ben Roberton, Simon Padley, Simon A Clarke. Chelsea and Westminster Hospital, London, UK

Neonatal chylothorax or chylous ascites can be caused by congenital lymphatic abnormalities or post-operative damage to the lymphatic system. Lymphangiography is a valuable tool for the diagnosis and treatment of lymphatic pathology. Here we present two cases in which lymphangiography was successfully used to plan for surgical thoracic duct ligation. We also performed a review of the literature regarding the use of lymphangiography in neonates.

P10 Replacing the robot: are articulating laparoscopic instruments the future of minimally-invasive surgery? 

Arun Kelay, Paul Charlesworth. Royal London Hospital, London, UK

Articulating instruments may bridge the gap between laparoscopy and robotics, thereby potentially representing the future of minimally-invasive surgery. Here we describe a feasibility study assessing the development of articulating laparoscopic skills.

P11 Vas deferens sparing laparoscopic removal of a large prostatic utricle. 

Mahmoud M. Marei, Tamás Cserni. Royal Manchester Children's Hospital, Manchester, UK

Introduction: Removal of a large prostatic utricle (PU) is a challenge due to the close proximity and the ectopic opening of the vasa deferentia into the utricle. We present a novel technique in children.

Case Presentation: A four-year-old boy with a large PU associated and penoscrotal hypospadias developed recurrent urinary tract infection (UTI), after a successful staged hypospadias repair.

Surgical Technique: We demonstrate a cystoscopy-assisted laparoscopic technique where a tubular structure, as an extension of the vas deferens, was created from the wall of the utricle on each side (lateral edge), leaving the vas connected to the urethra and the ejaculatory pathway. The redundant median (central) part of the utricle was excised.

Conclusion: Recovery was uneventful, and the patient remains asymptomatic to date (one year after surgery). A spermatogram may be obtained in the future, when age permits. This technique allows for preserving the vas whilst excising the utricle cyst, achieving the primary goal of preventing UTIs and prospects of sperm delivery.

P12 K-WIRE technique for Lap Pyeloplasty nephro-stenting - safety and efficacy. 

Sherif Abdelmaksoud, Abraham Cherian. Great Ormond Street Hospital, London, UK

This video presentation details the outcomes of the K-wire technique for placement of an externalized nephrostent in patients undergoing laparoscopic pyeloplasty. The technique was originally described by the senior author in 2018. This was performed on 38 consecutive patients from June 2016 to November 2019 with a median age of 30 m at the time of the procedure. No intraoperative complications were noted. The technique offers a viable, safe and effective method for placement of an externalized nephrostent and the superior advantage of avoiding a second general anaesthetic during stent removal.

P13 Minimally invasive simulation training in paediatric surgery – systematic review of literature and pilot study of the perceived impact of laparoscopic simulation training (LST) in paediatric surgery.

Teodora Ampirska, Catherine Bradshaw, Mallikarjuna Uppara. Bristol Royal Hospital for Children, Bristol, UK

The video presents the results of a systematic review of the literature of the current status and role of laparoscopic simulation training in paediatric surgery and of a local survey on the perceived role and benefits of laparoscopic simulation training in paediatric surgery. The types of validity tested was analysed and a Kirkpatrick training evaluation level was assigned for training programmes. A statistical analysis of the questionnaire was performed to test for its validity. Based on our studies we conclude that there is scope for further, focused work in the field and positive attitude towards LST in the UK. We propose a validated questionnaire to be used for a national study.

P14 Minimally Invasive Management of Polytrauma. 

David Thompson, Erica Makin, Shailesh Patel. King’s College Hospital, London, UK

A case presentation of a 15 year old penetrating polytrauma, demonstrating the role minimally invasive techniques can have in the management of selected paediatric polytrauma cases, avoiding the need for open trauma surgery.