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Jank M, Boettcher M, Keijzer R. Surgical management of the diaphragmatic defect in congenital diaphragmatic hernia: a contemporary review. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000747. [PMID: 39183804 PMCID: PMC11340723 DOI: 10.1136/wjps-2023-000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 07/15/2024] [Indexed: 08/27/2024] Open
Abstract
Worldwide, 150 children are born each day with congenital diaphragmatic hernia (CDH), a diaphragmatic defect with concomitant abnormal lung development. Patients with CDH with large defects are particularly challenging to treat, have the highest mortality, and are at significant risk of long-term complications. Advances in prenatal and neonatal treatments have improved survival in high-risk patients with CDH, but surgical treatment of large defects lacks standardization. Open repair by an abdominal approach has long been considered the traditional procedure, but the type of defect repair (patch or muscle flap) and patch material (non-absorbable, synthetic or absorbable, biological) remain subjects of debate. Increased experience and improved techniques in minimally invasive surgery (MIS) have expanded selection criteria for thoracoscopic defect repair in cardiopulmonary stable patients with small defects. However, the application of MIS to repair large defects remains controversial due to increased recurrence rates and unknown long-term effects of perioperative hypercapnia and acidosis resulting from capnothorax and reduced ventilation. Current recommendations on the surgical management rely on cohort studies of varying patient numbers and data on the long-term outcomes are sparse. Here, we discuss surgical approaches for diaphragmatic defect repair highlighting advancements, and knowledge gaps in surgical techniques (open surgery and MIS), patch materials and muscle flaps for large defects, as well as procedural adjuncts and management of CDH variants.
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Affiliation(s)
- Marietta Jank
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, Rady Faculty of Heath Sciences, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Surgery, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Richard Keijzer
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, Rady Faculty of Heath Sciences, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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2
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Bridges CJ, Hasson RM. Congenital Hernias in Adults: Bochdalek Hernias. Thorac Surg Clin 2024; 34:155-162. [PMID: 38705663 DOI: 10.1016/j.thorsurg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Bochdalek hernias are a rare occurrence in adults and usually asymptomatic, resulting in incidental discovery. However, surgical intervention is recommended for both symptomatic and asymptomatic Bochdalek hernias due to the risk of acute morbidity and mortality. There are various possible surgical approaches that may be appropriate depending on the circumstance, with robotic repair becoming increasingly popular. To date, the rarity of the condition has limited the available data on postoperative outcomes.
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Affiliation(s)
- Connor J Bridges
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Rian M Hasson
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; The Dartmouth Institute of Health Policy and Clinical Practice, Williamson Translational Research Building, Level 51 Medical Center Drive, Lebanon, NH 03756, USA.
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Hey MT, Mayhew M, Masterson S, Calisto J, Shaffiey S, Malvezzi L, Alkhoury F. The safe introduction of robotic surgery in a free-standing children's hospital. J Robot Surg 2023; 17:2369-2374. [PMID: 37421569 DOI: 10.1007/s11701-023-01663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023]
Abstract
The aim of this study is to report the experience of implementing a pediatric robotic surgery program at a free-standing pediatric teaching hospital. A database was created to prospectively collect perioperative data for all robotic surgeries performed by the pediatric surgery department. The database was queried for all operations completed from October 2015 to December 2021. Descriptive statistics were used to characterize the dataset, using median and interquartile ranges for continuous variables. From October 2015 to December 2021, a total of 249 robotic surgeries were performed in the department of pediatric surgery. Of the 249 cases, 170 (68.3%) were female and 79 (31.7%) were male. Across all patients, there was a median weight (IQR) of 62.65 kg (48.2-76.68 kg) and a median (IQR) age of 16 years (13-18 years). The median (IQR) operative time was 104 min (79.0-138 min). The median console time was 54.0 min (33.0-76.0 min) and the median docking time was 7 min (5-11 min). The majority of procedures were performed on the biliary tree (52.6%). In the 249 procedures, there were no technical failures of the robot and only two operations (0.8%) were converted to open procedures and one (0.4%) to laparoscopic. This study highlights the ability to successfully integrate a pediatric robotic surgery program into a free-standing children's hospital with a low conversion rate. Additionally, the program extended across multiple surgical procedures and offered real-time exposure to advanced surgical techniques for current and aspiring pediatric surgery trainees.
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Affiliation(s)
- Matthew T Hey
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
| | - Mackenzie Mayhew
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
| | - Stephanie Masterson
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA
| | - Juan Calisto
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA
| | - Shahab Shaffiey
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA
| | - Leopoldo Malvezzi
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA
| | - Fuad Alkhoury
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA.
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA.
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4
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Zhang MX, Zhang X, Chang XP, Zeng JX, Bian HQ, Cao GQ, Li S, Chi SQ, Zhou Y, Rong LY, Wan L, Tang ST. Robotic-assisted proctosigmoidectomy for Hirschsprung’s disease: A multicenter prospective study. World J Gastroenterol 2023; 29:3715-3732. [PMID: 37398887 PMCID: PMC10311611 DOI: 10.3748/wjg.v29.i23.3715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/29/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Robotic surgery is a cutting-edge minimally invasive technique that overcomes many shortcomings of laparoscopic techniques, yet few studies have evaluated the use of robotic surgery to treat Hirschsprung’s disease (HSCR).
AIM To analyze the feasibility and medium-term outcomes of robotic-assisted proctosigmoidectomy (RAPS) with sphincter- and nerve-sparing surgery in HSCR patients.
METHODS From July 2015 to January 2022, 156 rectosigmoid HSCR patients were enrolled in this multicenter prospective study. Their sphincters and nerves were spared by dissecting the rectum completely from the pelvic cavity outside the longitudinal muscle of the rectum and then performing transanal Soave pull-through procedures. Surgical outcomes and continence function were analyzed.
RESULTS No conversions or intraoperative complications occurred. The median age at surgery was 9.50 months, and the length of the removed bowel was 15.50 ± 5.23 cm. The total operation time, console time, and anal traction time were 155.22 ± 16.77, 58.01 ± 7.71, and 45.28 ± 8.15 min. There were 25 complications within 30 d and 48 post-30-d complications. For children aged ≥ 4 years, the bowel function score (BFS) was 17.32 ± 2.63, and 90.91% of patients showed moderate-to-good bowel function. The postoperative fecal continence (POFC) score was 10.95 ± 1.04 at 4 years of age, 11.48 ± 0.72 at 5 years of age, and 11.94 ± 0.81 at 6 years of age, showing a promising annual trend. There were no significant differences in postoperative complications, BFS, and POFC scores related to age at surgery being ≤ 3 mo or > 3 mo.
CONCLUSION RAPS is a safe and effective alternative for treating HSCR in children of all ages; it offers the advantage of further minimizing damage to sphincters and perirectal nerves and thus providing better continence function.
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Affiliation(s)
- Meng-Xin Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xi Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xiao-Pan Chang
- Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
| | - Ji-Xiao Zeng
- Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
| | - Hong-Qiang Bian
- Department of General Surgery, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430019, Hubei Province, China
| | - Guo-Qing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Shui-Qing Chi
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Ying Zhou
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Li-Ying Rong
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Li Wan
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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5
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Scrushy MG, Jacobson JC, Pandya SR, Gillory LA. Robotic repair of pediatric hernias: Current techniques and practices. Semin Pediatr Surg 2023; 32:151261. [PMID: 36736163 DOI: 10.1016/j.sempedsurg.2023.151261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The use of minimally invasive surgical techniques has gained popularity in pediatric surgery due to decreased length of stay, improved post-operative pain and smaller incisions. Laparoscopic assisted robotic surgical procedures are becoming more common in adults as they carry all of the benefits of traditional MIS but also allow for improved dexterity, visualization and surgeon ergonomics. In adults, hernia repairs are one of the most commonly performed robotic cases but adaption to pediatric repairs has been slower. Case reports and small case series have described a number of various types of pediatric hernia repairs including congenital diaphragmatic hernias, paraesophageal hernias and inguinal hernias. These cases have demonstrated that robotic repair of pediatric hernias is safe and feasible with minimal documented post-operative complications or recurrence. Future directions should focus on larger patient volume in order to assess outcomes between traditional laparoscopic and robotic approaches.
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Affiliation(s)
- Marinda G Scrushy
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA
| | - Jillian C Jacobson
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA
| | - Samir R Pandya
- Division of Pediatric Surgery, Children's Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX, 75235 USA; Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA
| | - Lauren A Gillory
- Division of Pediatric Surgery, Children's Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX, 75235 USA; Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA.
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6
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Mei H, Tang S. Robotic-assisted surgery in the pediatric surgeons' world: Current situation and future prospectives. Front Pediatr 2023; 11:1120831. [PMID: 36865692 PMCID: PMC9971628 DOI: 10.3389/fped.2023.1120831] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
Robotic-assisted surgery has been fully embraced by surgeons for the adult population; however, its acceptance is too slow in the world of pediatric surgeons. It is largely due to the technical limitations and the inherent high cost associated with it. In the past two decades, indeed, there has been considerable advancement in pediatric robotic surgery. A large number of surgical procedures were performed on children with the assistance of robots, even with comparative success rates to standard laparoscopy. As a newly developing field, it still has many challenges and obstacles. This work is centered on the current status and progression of pediatric robotic surgery as well as the future perspectives in the field of pediatric surgery.
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Affiliation(s)
- Hong Mei
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaotao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Xie S, Huang Y, He Y, Liu M, Wu D, Fang Y. Outcomes and comparations of pediatric surgery about choledochal cyst with robot-assisted procedures, laparoscopic procedures, and open procedures: A meta-analysis. Front Pediatr 2022; 10:968960. [PMID: 36034560 PMCID: PMC9403276 DOI: 10.3389/fped.2022.968960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background Choledochal cysts (CC) are rare disorders characterized by congenital biliary dilatation of the intrahepatic or extrahepatic bile ducts and always relate to pancreaticobiliary maljunction. Robot-assisted surgery has been able to complete almost all pediatric endoscopic surgery nowadays. But evidence of the post-operative outcomes of robotic-assisted operation is limited, comparing with the laparoscopic operation and traditional open operation. The aim of this meta-analysis was to identify the advantages and deficiencies about robotic-assisted operation for CC. Methods A meta-analysis of retrospective studies published in PUBMED, MEDLINE, Web of Science and China National Knowledge Infrastructure (CNKI). No date limit was used, with the last search on April 30, 2022. No publication restrictions or study design filters were applied. Results Nine retrospective cohort studies with 1,395 patients [366 in the robotic-assisted operation group (RG), 532 in the laparoscopic operation group (LG) and 497 in the open operation group (OG)] were enrolled in our study. Subgroup analysis demonstrated the RG had significant longer operative time [standardized mean difference (SMD) = 1.59, 95% CI = (0.02, 3.16), P < 0.05], less blood loss [SMD = -1.52, 95% CI = (-2.71, -0.32), P < 0.05], shorter enteral feeding time [SMD = -0.83, 95% CI = (-1.22, -0.44), P < 0.001], shorter time to stay in the hospital [SMD = -0.81, 95% CI = (-1.23, -0.38), P < 0.001], fewer post-operative complications [Relative risk (RR) =1.09, 95% CI = (1.04, 1.13), P < 0.001] but higher expenses [SMD = 8.58, 95% CI = (5.27, 11.89), P < 0.001] than LG. While a significant older age [SMD = 0.46, 95% CI = (0.26, 0.66), P < 0.001], longer operative time [SMD = 3.96, 95% CI = (2.38, 5.55), P < 0.001] and shorter time to stay in the hospital [SMD = -0.93, 95% CI = (-1.62, -0.25), P < 0.05] than OG. Conclusions Laparoscopic and robotic-assisted procedure are both safe and minimal invasive operational strategies. Robotic-assisted procedure may slowly surpass and has a trend to replace laparoscopy for its advantages. More experiences in robotic-assisted operation should be accumulated for the unexpected complexities, so as to be more stable in the younger age of children.
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Affiliation(s)
| | | | | | | | | | - Yifan Fang
- Department of Pediatric Surgery, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Children's Hospital, Fujian Medical University, Fuzhou, China
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Brownlee EM, Slack M. The Role of the Versius Surgical Robotic System in the Paediatric Population. CHILDREN 2022; 9:children9060805. [PMID: 35740742 PMCID: PMC9222178 DOI: 10.3390/children9060805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/05/2022]
Abstract
The uptake of robot-assisted surgery has continuously grown since its advent in the 1990s. While robot-assisted surgery is well-established in adult surgery, the rate of uptake in paediatric surgical centres has been slower. The advantages of a robot-assisted system, such as improved visibility, dexterity, and ergonomics, could make it a superior choice over the traditional laparoscopic approach. However, its implementation in the paediatric surgery arena has been limited primarily due to the unavailability of appropriately sized instruments as per paediatric body habitus, therefore, requiring more technologically advanced systems. The Versius surgical robotic system is a new modular platform that offers several benefits such as articulated instruments which pass through conventional 5 mm ports, compact arms for easier manoeuvrability and patient access, the ability to mimic conventional port placements, and adaptive machine learning concepts. Prior to its introduction to paediatric surgery, it needs to go through a careful pre-clinical and clinical research program.
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Affiliation(s)
- Ewan M. Brownlee
- Department of Paediatric Surgery and Urology, Southampton Children’s Hospital, University Hospital Southampton, Southampton SO16 6YD, UK;
| | - Mark Slack
- Clinical School, University of Cambridge, Cambridge CB2 2QQ, UK
- CMR Surgical Ltd., 1EBP, Milton Rd, Cambridge CB24 9NG, UK
- Correspondence: ; Tel.: +44-1223-755300 or +44-7766024389
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Ieiri S, Hino Y, Irie K, Taguchi T. Single incision laparoscopic repair for late-onset congenital diaphragmatic hernia using oval-shaped multichannel port device (E•Z ACCESS oval type)-2 months infantile case of Bochdalek hernia. Asian J Endosc Surg 2022; 15:235-239. [PMID: 34008334 DOI: 10.1111/ases.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/01/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Late-onset congenital diaphragmatic hernia constitutes 10%-36% of congenital diaphragmatic hernias. They qualify for endoscopic treatment including both thoracoscopic and laparoscopic approaches because this type of patient is in relatively stable condition compared with neonatal cases. However, single incision laparoscopic approach has not been reported. We herein report an infantile case of late-presenting diaphragmatic hernia who underwent single incision laparoscopic repair using an oval-shaped multichannel port device. MATERIALS AND SURGICAL TECHNIQUE A 2 month old female infant had sudden onset dyspnea with cyanosis and was diagnosed as having left diaphragmatic hernia (Bochdalek hernia) by chest X-ray. As her respiratory condition became stable under conservative treatment using combination of decompression of the gastrointestinal tract and mild sedation, we electively planned laparoscopic repair. Preoperative enhanced computed tomography imaging found that herniated organs were stomach, spleen, pancreatic tail, small intestine and right colon. The patient also had an umbilical hernia, so we decided to perform single incision repair through this umbilical hernia. Three trocars were introduced using an oval-shaped multichannel port device and herniated organs were reduced by gentle manipulation. The defect of the diaphragm was closed by bi-hand needle driving for upper and lower limb using a stay suture. The umbilical hernia was also repaired. Postoperative course was uneventful and no recurrence was recognized. DISCUSSION Wider trocar separation was achieved using the oval-shaped device, making the needle driving easier to perform. By using an oval-shaped multichannel port device and ingenuity of needle driving, single incision repair of infant diaphragmatic hernia was enabled.
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Affiliation(s)
- Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Yuko Hino
- Department of Pediatric Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiko Irie
- Department of Pediatric Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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10
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Doamba RN, Cherqui D, Bazongo M, Sahniyar A, Bonkoungou GP, Sanou A, Salloum C. [Bochdalek hernia with intrathoracic liver herniation in an adult patient treated with robotic surgery: a case report]. Pan Afr Med J 2021; 39:79. [PMID: 34422202 PMCID: PMC8363964 DOI: 10.11604/pamj.2021.39.79.23014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 11/11/2022] Open
Abstract
Une patiente de 45 ans reçue en consultation pour des douleurs isolées de l´hypochondre droit irradiant dans le dos, évoluant depuis plusieurs années. Elle n´avait pas d´antécédents médicaux. L'examen physique était sans particularités. La tomodensitométrie retrouvait une hernie diaphragmatique droite (hernie de Bochdalek) avec issue d´une partie du foie dans le thorax. La patiente a eu une cure herniaire par voie robotique. Les suites opératoires ont été simples. La patiente est actuellement à un an post-opératoire sans récidive. La hernie de Bochdalek avec issue hépatique en intrathoracique chez un adulte est une entité rare qui peut être traitée par voie robotique.
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Affiliation(s)
- Rodrigue Namèkinsba Doamba
- Centre Hépatobiliaire, Hôpital Paul Brousse Villejuif, Avenue Paul Vaillant Couturier, 94800 Villejuif, France.,Service de Chirurgie Générale et Spécialités Chirurgicales, Centre Hospitalier Universitaire Tengandogo, Ouagadougou, Burkina Faso
| | - Daniel Cherqui
- Centre Hépatobiliaire, Hôpital Paul Brousse Villejuif, Avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - Moussa Bazongo
- Service de Chirurgie Générale et Spécialités Chirurgicales, Centre Hospitalier Universitaire Tengandogo, Ouagadougou, Burkina Faso
| | - Aida Sahniyar
- Centre Hépatobiliaire, Hôpital Paul Brousse Villejuif, Avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - Gilbert Patindé Bonkoungou
- Service de Chirurgie Générale et Spécialités Chirurgicales, Centre Hospitalier Universitaire Tengandogo, Ouagadougou, Burkina Faso
| | - Adama Sanou
- Service de Chirurgie Générale et Spécialités Chirurgicales, Centre Hospitalier Universitaire Tengandogo, Ouagadougou, Burkina Faso
| | - Chady Salloum
- Centre Hépatobiliaire, Hôpital Paul Brousse Villejuif, Avenue Paul Vaillant Couturier, 94800 Villejuif, France
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11
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Richards HW, Kulaylat AN, Cooper JN, McLeod DJ, Diefenbach KA, Michalsky MP. Trends in robotic surgery utilization across tertiary children’s hospitals in the United States. Surg Endosc 2020; 35:6066-6072. [DOI: 10.1007/s00464-020-08098-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
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Hunter LM, Mozer AB, Anciano CJ, Oliver AL, Iannettoni MD, Speicher JE. Robotic-Assisted Thoracoscopic Repair of Right-Sided Bochdalek Hernia in Adults: A Two-Case Series. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:69-74. [PMID: 30848706 DOI: 10.1177/1556984518823642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bochdalek hernia is a congenital diaphragmatic hernia that presents rarely in adulthood. Because of the paucity of cases, no standard repair technique has been identified. Here we present two cases of robotic, thoracoscopic repair of this rare hernia defect. Two separate adult patients with right-sided abdominal pain presented to the emergency department for evaluation. Both patients were diagnosed with right-sided Bochdalek hernia and repair was undertaken with a robotic, transthoracic approach. Repair technique is described in detail, including port placement, dissection technique, and repair strategy. Advantages of the robotic, transthoracic approach are discussed in detail. A transthoracic minimally invasive approach using a robotic platform is noted to be both feasible and practical in the treatment of adult Bochdalek hernia.
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Affiliation(s)
- Lucas M Hunter
- 1 Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Anthony B Mozer
- 1 Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Carlos J Anciano
- 1 Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Aundrea L Oliver
- 1 Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Mark D Iannettoni
- 1 Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - James E Speicher
- 1 Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, NC, USA
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13
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Abstract
A review of the current status of robotic surgery use in paediatrics.
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Affiliation(s)
- Joshua Cave
- Chelsea and Westminster NHS Foundation Trust
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14
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Design, Modelling and Teleoperation of a 2 mm Diameter Compliant Instrument for the da Vinci Platform. Ann Biomed Eng 2018; 46:1437-1449. [PMID: 29736692 DOI: 10.1007/s10439-018-2036-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
Abstract
This work explores the feasibility of creating and accurately controlling an instrument for robotic surgery with a 2 mm diameter and a three degree-of-freedom (DoF) wrist which is compatible with the da Vinci platform. The instrument's wrist is composed of a two DoF bending notched-nitinol tube pattern, for which a kinematic model has been developed. A base mechanism for controlling the wrist is designed for integration with the da Vinci Research Kit. A basic teleoperation task is successfully performed using two of the miniature instruments. The performance and accuracy of the instrument suggest that creating and accurately controlling a 2 mm diameter instrument is feasible and the design and modelling proposed in this work provide a basis for future miniature instrument development.
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Jambhekar A, Robinson S, Housman B, Nguyen J, Gu K, Nakhamiyayev V. Robotic repair of a right-sided Bochdalek hernia: a case report and literature review. J Robot Surg 2017; 12:351-355. [DOI: 10.1007/s11701-017-0705-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
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16
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Current perspectives in robotic assisted pediatric surgery. APOLLO MEDICINE 2014. [DOI: 10.1016/j.apme.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Chaussy Y, Becmeur F, Lardy H, Aubert D. Robot-Assisted Surgery: Current Status Evaluation in Abdominal and Urological Pediatric Surgery. J Laparoendosc Adv Surg Tech A 2013; 23:530-8. [DOI: 10.1089/lap.2012.0192] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Yann Chaussy
- Department of Pediatric Surgery, Hospital Saint-Jacques, Centre Hospitalier Regional Universitaire de Besançon, Besançon, France
| | - François Becmeur
- Department of Pediatric Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Clocheville Hospital, Centre Hospitalier Regional Universitaire de Tours, Tours, France
| | - Didier Aubert
- Department of Pediatric Surgery, Hospital Saint-Jacques, Centre Hospitalier Regional Universitaire de Besançon, Besançon, France
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Bianchi E, Mancini P, De Vito S, Pompili E, Taurone S, Guerrisi I, Guerrisi A, D'Andrea V, Cantisani V, Artico M. Congenital asymptomatic diaphragmatic hernias in adults: a case series. J Med Case Rep 2013; 7:125. [PMID: 23668793 PMCID: PMC3668166 DOI: 10.1186/1752-1947-7-125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 03/05/2013] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Congenital diaphragmatic hernia is a major malformation occasionally found in newborns and babies. Congenital diaphragmatic hernia is defined by the presence of an orifice in the diaphragm, more often to the left and posterolateral, that permits the herniation of abdominal contents into the thorax. The aim of this case series is to provide information on the presentation, diagnosis and outcome of three patients with late-presenting congenital diaphragmatic hernias. The diagnosis of congenital diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray films and computed tomography scans. CASE PRESENTATIONS In the present report three cases of asymptomatic abdominal viscera herniation within the thorax are described. The first case concerns herniation of some loops of the large intestine into the left hemi-thorax in a 75-year-old Caucasian Italian woman. The second case concerns a rare type of herniation in the right side of the thorax of the right kidney with a part of the liver parenchyma in a 57-year-old Caucasian Italian woman. The third case concerns herniation of the stomach and bowel into the left side of the chest with compression of the left lung in a 32-year-old Caucasian Italian man. This type of hernia may appear later in life, because of concomitant respiratory or gastrointestinal disease, or it may be an incidental finding in asymptomatic adults, such as in the three cases featured here. CONCLUSIONS Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms, and diagnosis may be difficult. Additional investigation and research appear necessary to better explain the development and progression of this type of disease.
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Affiliation(s)
- Enrica Bianchi
- Department of Anatomical, Histological, Forensic and Locomotor System Sciences, V, A, Borelli 50, Rome, 00161, Italy.
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19
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The first decade of robotic surgery in children. J Pediatr Surg 2013; 48:858-65. [PMID: 23583146 DOI: 10.1016/j.jpedsurg.2013.01.031] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/03/2013] [Accepted: 01/20/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Robotic surgery offers technological solutions to current challenges of minimal access surgery, particularly for delicate and dexterous procedures within spatially constrained operative workspaces in children. The first robotic surgical procedure in a child was reported in April 2001. This review aims to examine the literature for global case volumes, trends, and quality of evidence for the first decade of robotic surgery in children. METHODS A systematic literature search was performed for all reported cases of robotic surgery in children during the period of April 2001 to March 2012. RESULTS Following identification of 220 relevant articles, 137 articles were included, reporting 2393 procedures in 1840 patients. The most prevalent gastrointestinal, genitourinary, and thoracic procedures were fundoplication, pyeloplasty, and lobectomy, respectively. There was a progressive trend of increasing number of publications and case volumes over time. The net overall reported conversion rate was 2.5%. The rate of reported robot malfunctions or failures was 0.5%. CONCLUSIONS Robotic surgery is an expanding and diffusing innovation in pediatric surgery. Future evolution and evaluation should occur simultaneously, such that wider clinical uptake may be led by higher quality and level of evidence literature.
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Tsao K, Lally KP. Innovations in the surgical management of congenital diaphragmatic hernia. Clin Perinatol 2012; 39:363-74. [PMID: 22682385 DOI: 10.1016/j.clp.2012.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Surgical management of congenital diaphragmatic hernia (CDH) remains a challenge for all clinicians. While the treatment strategies for CDH have evolved from emergent surgical intervention to initial hemodynamic stabilization with delayed surgical repair, surgical innovations have remained limited in the last 20 years. Advances in surgical approaches, such as minimally invasive surgery and alternatives to diaphragmatic replacement, have focused on improvements in surgical morbidity.
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Affiliation(s)
- KuoJen Tsao
- Department of Pediatric Surgery, The University of Texas School of Medicine at Houston, Houston, TX 77030, USA.
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21
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Krauss A, Neumuth T, Wachowiak R, Donaubauer B, Korb W, Burgert O, Muensterer OJ. Laparoscopic versus robot-assisted Nissen fundoplication in an infant pig model. Pediatr Surg Int 2012; 28:357-62. [PMID: 22200733 DOI: 10.1007/s00383-011-3045-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgical robots are designed to facilitate dissection and suturing, although objective data on their superiority are lacking. This study compares conventional laparoscopic Nissen fundoplication (CLNF) to robot-assisted Nissen fundoplication (RANF) using computer-based workflow analysis in an infant pig model. METHODS CLNF and RANF were performed in 12 pigs. Surgical workflow was segmented into phases. Time required to perform specific actions was compared by t test. The quality of knot-tying was evaluated by a skill scoring system. Cardia yield pressure (CYP) was determined to test the efficacy of the fundoplications, and the incidence of complications was compared. RESULTS There was no difference in average times to complete the various phases, despite faster robotic knot-tying (p = 0.001). Suturing quality was superior in CLNF (p = 0.02). CYP increased similarly in both groups. Workflow-interrupting hemorrhage and pneumothorax occurred more frequently during CLNF (p = 0.040 and 0.044, respectively), while more sutures broke during RANF (p = 0.001). CONCLUSION The robot provides no clear temporal advantage compared to conventional laparoscopy for fundoplication, although suturing was faster in RANF. Fewer complications were noted using the robot. RANF and CLNF were equally efficient anti-reflux procedures. For robotic surgery to manifest its full potential, more complex operations may have to be evaluated.
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Affiliation(s)
- Alexandra Krauss
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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22
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Abstract
Congenital Diaphragmatic Hernia (CDH) is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. About one third of cases have cardiovascular malformations and lesser proportions have skeletal, neural, genitourinary, gastrointestinal or other defects. CDH can be a component of Pallister-Killian, Fryns, Ghersoni-Baruch, WAGR, Denys-Drash, Brachman-De Lange, Donnai-Barrow or Wolf-Hirschhorn syndromes. Some chromosomal anomalies involve CDH as well. The incidence is < 5 in 10,000 live-births. The etiology is unknown although clinical, genetic and experimental evidence points to disturbances in the retinoid-signaling pathway during organogenesis. Antenatal diagnosis is often made and this allows prenatal management (open correction of the hernia in the past and reversible fetoscopic tracheal obstruction nowadays) that may be indicated in cases with severe lung hypoplasia and grim prognosis. Treatment after birth requires all the refinements of critical care including extracorporeal membrane oxygenation prior to surgical correction. The best hospital series report 80% survival but it remains around 50% in population-based studies. Chronic respiratory tract disease, neurodevelopmental problems, neurosensorial hearing loss and gastroesophageal reflux are common problems in survivors. Much more research on several aspects of this severe condition is warranted.
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Kesieme EB, Kesieme CN. Congenital diaphragmatic hernia: review of current concept in surgical management. ISRN SURGERY 2011; 2011:974041. [PMID: 22229104 PMCID: PMC3251163 DOI: 10.5402/2011/974041] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/26/2011] [Indexed: 11/23/2022]
Abstract
CONGENITAL DIAPHRAGMATIC HERNIAS (CDHS) OCCUR MAINLY IN TWO LOCATIONS: the foramen of Morgagni and the more common type involving the foramen of Bochdalek. Hiatal hernia and paraesophageal hernia have also been described as other forms of CDH. Pulmonary hypertension and pulmonary hypoplasia have been recognized as the two most important factors in the pathophysiology of congenital diaphragmatic hernia. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, introduction of fetal intervention due to improved prenatal diagnosis, the introduction of minimal invasive surgery, in addition to the standard open repair, and the use of improved prosthetic devices for closure.
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Affiliation(s)
- Emeka B. Kesieme
- Department of Surgery, Irrua Specialist Teaching Hospital, PMB 8, Edo State, Irrua, Nigeria
| | - Chinenye N. Kesieme
- Department of Paediatrics, Irrua Specialist Teaching Hospital, PMB 8, Edo State, Irrua, Nigeria
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Robotics for the surgical treatment of pediatric patients: an overview. JAAPA 2011; 24:39-42. [PMID: 21682176 DOI: 10.1097/01720610-201106000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Robotic-assisted surgery in children: advantages and limitations. J Robot Surg 2010; 4:19-22. [DOI: 10.1007/s11701-010-0181-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 03/29/2009] [Indexed: 10/19/2022]
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Slater BJ, Meehan JJ. Robotic repair of congenital diaphragmatic anomalies. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S123-7. [PMID: 19260792 DOI: 10.1089/lap.2008.0200.supp] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Congenital diaphragm anomalies, including eventration, Morgagni diaphragmatic hernias (M-CDH), and Bochdalek diaphragmatic hernias (B-CDH), have been successfully repaired by using minimally invasive surgery (MIS). However, some reports have shown a high recurrence rate for some defects, potentially due to difficulty associated with the rigid instruments. Robotic surgery may help close diaphragmatic anomalies more effectively. In this paper, we present a series of 8 consecutive patients with diaphragmatic anomalies who underwent robotic repair. METHODS We retrospectively reviewed patients with diaphragmatic anomalies. There were 2 patients with eventration, 5 with B-CDH, and 1 with M-CDH. All procedures were performed by using the Standard Da Vinci surgical robot (Intuitive Surgical, Sunnyvale, CA) with one camera arm (5-mm two-dimensional scope) and two instrument arms (5 mm). RESULTS Average age was 3.9 months (4 days to 12 months). Average weight was 3.6 kg (range, 2.2-10.5). Four B-CDH patients were approached through the chest and 1 from the abdomen. The patient with M-CDH had an abdominal repair, and both eventrations were performed from the chest. One B-CDH and 1 eventration were converted to thoracoscopic procedures. Average operative time was 1 hour and 20 minutes. One recurrence developed in a relatively large B-CDH repair that was closed primarily. Average follow-up was 20 months. CONCLUSIONS Robotic surgery is safe and effective for repairing diaphragm anomalies in small children. Although we prefer the thoracic approach for repairing the B-CDH, occasionally smaller newborns-perhaps those less than 2.5 kg-may do better with the abdominal approach, since the articulating instruments requiring a significant length in order to maneuver.
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Affiliation(s)
- Bethany J Slater
- Department of Surgery, Stanford University Hospital and Clinics, Palo Alto, California, USA
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Abstract
OBJECTIVES This article reviews the evidence regarding the feasibility, safety, benefits, limitations, and costs of robotically assisted surgery in children, evaluates how the technology compares with other pediatric surgical techniques, and provides insights about the near and more-distant future of the technology. METHODS The peer-reviewed medical pediatric literature was searched for studies that provided evidence of the feasibility and safety of robotic surgery in children and for studies that compared pediatric robotic surgery with conventional laparoscopic surgery or open surgery. RESULTS A total of 8 case series and 5 studies comparing robotic surgery with open or conventional laparoscopic surgery met the selection criteria for review. A few small studies that focused on rare complex surgical procedures also were reviewed. All studies were designed to evaluate the feasibility and safety of robotic surgery in children. None of the studies was randomized, and some studies had a retrospective design. These studies demonstrated that a number of routine, robotically assisted, laparoscopic and thoracic procedures were feasible and safe when performed by surgeons experienced in the technique, although robotic surgery did not provide superior outcomes, compared with traditional laparoscopic and open surgery. The advantages of the robotic system were best seen in complex procedures that involved areas that were difficult to access and in procedures in which dissection of delicate, anatomic structures was required. CONCLUSIONS Robotic surgery is feasible and safe for a number of pediatric surgical procedures, but evidence that it offers better clinical outcomes than conventional open or laparoscopic techniques is lacking.
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Affiliation(s)
- Goedele van Haasteren
- Hayes Inc, Independent Health Technology Assessment Company, Lansdale, Pennsylvania 19446, USA.
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28
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Meehan JJ. Robotic Surgery in Small Children: Is There Room for This? J Laparoendosc Adv Surg Tech A 2009; 19:707-12. [DOI: 10.1089/lap.2008.0178] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- John J. Meehan
- Division of Pediatric Surgery, Seattle Children's Hospital and Regional Medical Center, University of Washington, Seattle, Washington
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29
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Durkin EF, Shaaban A. Commonly encountered surgical problems in the fetus and neonate. Pediatr Clin North Am 2009; 56:647-69, Table of Contents. [PMID: 19501697 DOI: 10.1016/j.pcl.2009.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Neonatal surgical care requires a current understanding of pre- and postnatal intervention for a myriad of congenital anomalies. This article includes an update of the recent information on commonly encountered fetal and neonatal surgical problems, highlighting specific areas of controversy and challenges in diagnosis. The authors hope that this article is useful for trainees and practitioners involved in any aspect of fetal and neonatal care.
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Affiliation(s)
- Emily F Durkin
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, H4/325 Clinical Science Center, Madison, WI 53798, USA
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DeUgarte DA, Hirschl RB, Geiger JD. Robotic Repair of Congenital Paraesophageal Hiatal Hernia. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S187-9. [DOI: 10.1089/lap.2008.0185.supp] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel A. DeUgarte
- Division of Pediatric Surgery, UCLA School of Medicine, Los Angeles, California
| | - Ronald B. Hirschl
- Division of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan
| | - James D. Geiger
- Division of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan
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31
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DeUgarte DA, Hirschl RB, Geiger JD. Robotic repair of congenital paraesophageal hiatal hernia. J Laparoendosc Adv Surg Tech A 2009. [PMID: 19331624 DOI: 10.1089/lap.2008.0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Congenital paraesophageal hiatal hernias are rare and can be associated with gastric incarceration, volvulus,mucosal ulceration, and anemia. Primary repair of the hernia and fundoplication are recommended. In this paper,we report a case of a 3-year-old child with abdominal pain who was noted to have a paraesophageal hiatal hernia with partial gastric volvulus. A 5 mm robot platform was utilized to facilitate hernia sac dissection,hiatal repair, and fundoplication.
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Affiliation(s)
- Daniel A DeUgarte
- Division of Pediatric Surgery, UCLA School of Medicine, Los Angeles, CA, USA.
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32
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Robotic repair of Morgagni congenital diaphragmatic hernia in an infant. J Robot Surg 2008; 2:97-9. [DOI: 10.1007/s11701-008-0081-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Accepted: 04/06/2008] [Indexed: 10/22/2022]
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