Pediatric single-incision laparoscopy "virtually scarless"

"When laparoscopy was first used in pediatrics, parents would marvel that their child's surgery was done using only very small incisions," said David Wahoff, MD, PhD, a surgeon with Pediatric Surgical Associates and a Children's professional staff member. "But now, with single-incision laparoscopy, there's really no visible scar. Parents just can't believe it's virtually scarless."

While single-incision laparoscopy has been conducted for more than a decade on adult patients, it only recently has been performed on pediatric patients.

Wahoff is one of only a handful of surgeons in the Twin Cities to perform single-incision laparoscopic procedures on pediatric patients.

Because single-incision laparoscopy involves only a small incision through a patient's umbilicus, the procedure is as close to a scarless procedure as there exists today.

How it works

  • The procedure uses specialized instrumentation, including a port, which facilitates the insertion of three cannulae through which instruments are passed.
  • The instruments work together to provide surgeons with 360-degree rotation and hand-like access to a patient's abdomen.
  • The port also features a valve that allows surgeons to inflate the abdomen for optimal instrument access.

Advantages over open surgery

  • greatly reduced pain and scar tissue
  • a faster recovery
  • much lower incidence of infection

Advantages over multi-point laparoscopy

  • less pain for patients
  • virtually no scarring
  • minimal recovery time

"A real paradigm shift"

The three most common pediatric procedures that single-incision laparoscopy is used for are cholecystectomies, appendectomies and intestinal resections, often in instances of Crohn's disease.

In adults, the procedure has been used to treat an ever-growing list of complex gynecologic, urologic and colorectal conditions. Wahoff believes the procedure’s use in pediatric patients will follow a similar course.

"As we move forward, I think most pediatric procedures will at least be attempted through a single site and expanded to a multi-site laparoscopy only if the situation warrants," said Wahoff, who has performed laparoscopic procedures on children for more than 12 years.

"It represents a continued movement toward minimally invasive techniques — a real paradigm shift."

New food allergy testing program

In September 2011, Children’s hospitalist program, along with five Twin Cities-area allergists (see list below), introduced a program that will allow children with significant food allergies to be tested by Children’s Hospitalist group to determine if their ability to tolerate the allergens has increased. 

This program is a response to requests by allergists to develop a program that will allow testing by the Hospitalist group for these children who, due to risk of anaphylaxis, must be observed for long periods of time. The testing is currently being conducted in Children’s Short Stay Unit by the individual allergists.

For more information on this program, including allergists wishing to take part in the program, please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it. , medical director of Children’s hospitalist program.

Allergists involved in the program:

Thomas Helm, MD
Allergy and Asthma Care
Maple Grove

Nancy Ott, MD
Southdale Pediatric Associates

Naveen Sikka, MD
St. Paul Allergy & Asthma
St Paul

Allan Stillerman, MD
Allergy & Asthma Specialists

Michael Wexler, MD
Advancements in Allergy and Asthma

Craniofacial reconstruction and remodeling part of Cleft and Craniofacial Program expansion

Cleft lip and palate are among the most common birth defects — affecting approximately one in 700 newborns. In response, the Cleft and Craniofacial Program at Children's has expanded its services. The largest growth has been in major craniofacial reconstruction and remodeling for infants and young children.

The evaluation of children diagnosed with craniosynostosis, Aperts and Crouzon's syndromes is overseen by Joe Petronio, MD, and Bob Tibesar, MD, who help lead a multidisciplinary craniofacial team. The team, which includes surgeons, geneticists, nurse practitioners, feeding specialists, oral surgeons, psychologists and social workers, evaluates patients in a collaborative setting.

Patients are evaluated at both the Children's - St. Paul and Children's - Minneapolis campuses, and the plagiocephaly team meets weekly in St. Paul, Minneapolis, and at Children's Minnetonka to evaluate plagiocephaly and institute helmeting protocols.

The evaluation and management of speech disorders in craniofacial and other syndromic patients is another area of recent growth for the program. The care team includes speech pathologists from all campuses and allows for an integrated approach to treating speech abnormalities which involves local providers and Children's specialists.

For more on Children's Cleft and Craniofacial Program, including patient education resources and information on how to refer a patient, go online or call Children's Physician Access, 612-343-2121; 866-755-2121

Children’s and St. Cloud Hospital partner on cancer/blood disorders pediatric care

Children’s and St. Cloud Hospital partner on cancer/blood disorders pediatric care  
Children in Central Minnesota needing pediatric specialty care for cancer and blood disorders will now be able to stay closer to home through an expanded partnership between St. Cloud Hospital and Children’s Hospitals and Clinics of Minnesota.

The new formalized cancer and blood disorders partnership will: 
•    Keep children closer to their family, doctor and home when possible, and provide a continuum of care to Children’s - Minneapolis campus when specialized care is required.
•    Give St. Cloud Hospital access to Children’s treatment guidelines, protocols and recommendations. 
•    Allow oncologists and hematologists from Children’s to be more present at St. Cloud Hospital, scheduling outpatient visits several days each month.
•    Help improve the lives of sick children and drive better outcomes through co-management and coordination of  care at the site that is most appropriate for treatment and for patients and their families.
•    Provide educational opportunities for physicians related to pediatric cancer and blood disorder specialty care. 

The partnership helps meet the growing and evolving medical needs of patients and families throughout Central Minnesota by improving access to high quality, family-centered care for kids fighting cancer and blood disorders. It formalizes a 10-year relationship between St. Cloud Hospital and Children’s and allows both organizations to builds upon the success of a collaborative care model. Already the new partnership has helped St. Cloud Hospital form a Pediatric Sedation Program this past spring, and talks are underway to expand the relationship into neurosciences within the next year.

New Immune Dysregulation Clinic opens in November

Children's new Immune Dysregulation Clinic (IDC) is a multispecialty collaborative clinic including staff from Pediatric Infectious Disease/Immunology, Pediatric Rheumatology, and Pediatric Hematology/Oncology.  The IDC will provide evaluation and treatment for children with diseases resulting from immune system dysregulation such as hemophagocytic lymphohistiocytosis (HLH) and others.

The IDC is located within the Pediatric Hematology/Oncology Clinic/CH Robinson Infusion Center.  Appointments are available beginning November 16, 2011 and can be scheduled through the Pediatric Hematology Oncology Clinic at 612-813-5940, or via Children's Physician Access.

Medical staff include: Tamara Pozos, MD, PhD; Mona LaPlant, MD; Joanna Perkins, MD, MS; Michael Richards, MD, PhD; Dawn Niess, PNP; Melissa Christensen, PNP; Kristine Johnston, RN; Mary Sue Monroe, RN.