Emerging technology and their application to paediatric surgical training

Virtual Reality for Preoperative Planning and Education in Pediatric Surgery: Preliminary Results for the Treatment of Congenital Malformations and Tumors

PURPOSE

Virtual reality (VR) has emerged as a valuable tool in surgical planning, offering detailed anatomical spatial orientation and three-dimensional (3D) navigation. This study explores using virtual reality head-mounted display (VR-HMD) technology in preoperative planning for pediatric surgery, aiming to improve outcomes in treating congenital malformations and tumors while advancing surgical education.

METHODS

A retrospective analysis was performed on pediatric patients diagnosed with congenital malformations and tumors who received treatment between 2021 and 2024 at the "V. Buzzi" Children's Hospital in Milan, Italy. Patient-specific 3D VR models were generated from reconstructed computed tomography/magnetic resonance imaging (CT/MRI) images and analyzed preoperatively to optimize surgical planning and strategy development. The advantages of preoperative VR compared to traditional imaging techniques were assessed.

RESULTS

Fifty VR models were included in the study (n = 35: congenital malformations and n = 15 tumors). The VR-HMD setup facilitated interactive anatomical exploration, enabling precise surgical navigation and planning. Compared to conventional imaging, preoperative VR simulations modified the surgical approach in 75.0% of cases, enabling minimally invasive strategies in complex congenital malformations and guiding the decision for open surgery in anatomically challenging tumors such as adrenal and hepatic masses. VR images demonstrated superior anatomical resolution and identified potential intraoperative complications in 92.0% of cases compared to conventional imaging. Remarkably, examining the vascular hilum in pulmonary, hepatic, and renal structures provided enhanced guidance for determining the surgical approach, ensuring a safer and more precise respect for the anatomy in complex cases. As a result, preoperative VR navigation demonstrated the feasibility of minimally invasive procedures in 45.6% of complex cases whereas recommending an open surgical approach in 55.4% of the models. Limitations in visualizing urological structures (e.g., ureters and bladder in complex urogenital malformations) limited the VR's utility in those cases, underscoring the need for future advancements in segmentation and multimodal imaging to enhance anatomical accuracy.

CONCLUSION

Preoperative VR enables customized surgical planning, potentially minimizes intraoperative risks, and provides valuable educational opportunities for pediatric surgical teams. Future advancements in VR technology promise to further enhance its integration into clinical practice, ultimately improving pediatric patients' outcomes.

Development and Validation of a Laparoscopy Simulation Model of Pyeloplasty for Pediatric Patients

Introduction: Given the extensive training required for laparoscopic pyeloplasty and the difficulties achieving this training, there is a need to recreate the activity in a controlled environment, but high-fidelity models are unavailable or expensive. Our objective was to develop a model of pyeloureteral junction stenosis, resembling the anatomical details and consistency of natural tissue, for a replicable, cheaper, and realistic simulation model of laparoscopic pyeloplasty in children. Materials and Methods: A three-dimensional, printed synthetic model was created from magnetic resonance urography. The model comprises a plastic kidney as the reusable structure and a silicone renal pelvis and ureter as the interchangeable structure. We evaluated realism and performance with surgeons and residents at different levels of training, comparing operative time and complications of the procedure. Results: Twenty-four participants were recruited; 41.7% had previous experience in laparoscopic pyeloplasty, with 5.5 years of experience in laparoscopic surgery (interquartile range [IQR] 2-7.75). There were no cases of stenosis, but leaks accounted for 41.7%. The procedure lasted 72 minutes (IQR 55-90), with significant differences according to the level of training (85 minutes for residents, 68 minutes for pediatric surgeons and urologists, and 40 minutes for laparoscopic surgeons; P: .011) and years of previous experience in laparoscopic surgery (P: .003). Conclusions: A high-fidelity, replicable, and low-cost pyeloureteral stenosis model was developed to simulate laparoscopic pyeloplasty in pediatric patients.

Current assessment of parental and health professional perception of the colour of neonatal vomiting: Results of a scoping survey

PURPOSE

To determine current perceptions of doctors, nurses and parents for the colour of a neonatal vomit which should prompt an urgent surgical review.

METHODS

A voluntary scoping survey of parents/guardians of patients and non-surgical healthcare professionals was conducted with respondents asked to choose from 8 different selections in a colour swatch from pale yellow to dark green. A control group consisted of 13 paediatric surgeons. Data were analysed using the paired t test, Fishers exact test. A p value of < 0.05 was considered to be significant.

RESULTS

365 participants responded: 36% (131/365) parents, 18% (64/365) nurses and 46% (166/365) doctors. 4/365 (1%) did not state their role. 343 participants completed all questions and responses were analysed using total responses for each question. 82% (121/148) of doctors and 78% (50/64) of nurses had more than 3 years of post-graduate experience. Overall, 63% (227/361) of participants (100% paediatric surgeons, 78% other doctors, 75% nurses/midwives & 30% parents) considered dark and light green vomits to be a sign of intestinal obstruction. 67% (242/361) of participants (100% paediatric surgeons, 72% other doctors, 56% nurses/midwives and 62% parents) believed dark and light green vomiting needed an urgent surgical referral. There were significant differences between the control group and other groups in terms of whether the neonate could wait until the next day for a review; nursing staff (p = 0.0002), postnatal/midwifery (p =  < 0.0001), emergency medicine (p = 0.04), general practice (p = 0.002), neonatal (p = 0.0001) and paediatricians (p = 0.005). Only the neonatologists (p = 0.04), nursing staff (p = 0.001) and postnatal/midwifery (p = 0.004) believed that the neonate could have safe observation.

CONCLUSION

Although the perception that green vomiting is potentially serious is acknowledged by the majority of healthcare professionals surveyed, there is still a requirement for more targeted educational practices in nursing, midwifery and medical staff.

Virtual Education in Pediatric Surgery during the COVID-19 Era: Facing and Overcoming Current Challenges

The novel coronavirus disease 2019 (COVID-19) pandemic has impacted our way of living in an unprecedented manner. Medical professionals at all levels have been forced to adapt to the novel virus. The delivery of surgical services and the subsequent learning opportunities for surgical residents have especially been disrupted and the pediatric surgical community has not been exempted by this. This article highlights the challenges imposed by the pandemic and outlines the various learning modalities that can be implemented to ensure continued learning opportunities throughout the pandemic and beyond. Furthermore, it aims to show how the utilization and expansion of technologies maintain and further increase the communication, as well as the exchange of and access to knowledge among peers. Virtual education-, application-, and simulation-based learning and social media, as well as telemedicine and online conferences, will play a considerable role in the future of surgical specialties and surgical education.