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Cruz SM, Srinivas S, Wala SJ, Head WT, Michalsky MP, Aldrink JH, Diefenbach KA. Robotic-assisted minimally invasive surgery: Foregut procedures in pediatric patients. Semin Pediatr Surg 2023; 32:151256. [PMID: 36746111 DOI: 10.1016/j.sempedsurg.2023.151256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
| | | | | | - W Taylor Head
- Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State School of Medicine, Columbus, OH, USA
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Harris CJ, Lautz TB, Rowell EE. Feasibility of laparoscopic ovarian tissue cryopreservation after open abdominopelvic tumor surgery. Am J Surg 2020; 220:1249-1252. [PMID: 32723489 DOI: 10.1016/j.amjsurg.2020.06.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/18/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic oophorectomy with tissue cryopreservation (OTC) for fertility preservation is usually performed prior to therapy. When fertility preservation is considered after prior open abdominopelvic tumor surgery there may be a perceived barrier to laparoscopic OTC. This study evaluates the feasibility of OTC with a laparoscopic approach after open surgery. METHODS This is a single institution retrospective study from 2011 to 2019. RESULTS Planned laparoscopic OTC was performed after open surgery in 17 of 113 patients. Median age was 4.2 years. The most common diagnoses were Wilms Tumor (35%) and neuroblastoma (35%). The most common procedures were nephrectomy (41%) and exploratory laparotomy with biopsy (35%). The median amount of time between open surgery and OTC was 29 days. Sixteen (94%) had a laparoscopic OTC. Regardless of operative technique, patients resumed therapy a median of 3 days after OTC. CONCLUSIONS Prior abdominopelvic surgery should not be a barrier to OTC. Laparoscopic OTC is feasible after a variety of open oncologic operations, regardless of time-interval between the procedures and without incurring a significant delay in resuming oncologic therapy.
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Affiliation(s)
- Courtney J Harris
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N St. Clair St., Arkes Suite 2320, Chicago, IL, 60611, USA; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 63, Chicago, IL, 60611, USA.
| | - Timothy B Lautz
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N St. Clair St., Arkes Suite 2320, Chicago, IL, 60611, USA; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 63, Chicago, IL, 60611, USA
| | - Erin E Rowell
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N St. Clair St., Arkes Suite 2320, Chicago, IL, 60611, USA; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 63, Chicago, IL, 60611, USA
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Romnek MJ, Diefenbach K, Tumin D, Tobias JD, Kim S, Thung A. Postoperative Clinical Course and Opioid Consumption Following Repair of Congenital Diaphragmatic Hernia: Open Versus Thoracoscopic Techniques. J Laparoendosc Adv Surg Tech A 2020; 30:590-595. [PMID: 32267796 DOI: 10.1089/lap.2019.0510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Minimally invasive surgical (MIS) approaches for thoracic procedures in adults result in an improved postoperative course with less pain, but there are limited data on similar procedures in neonates. We aimed to evaluate postoperative opioid consumption and pain management practices in neonates and infants following MIS versus open repair of congenital diaphragmatic hernia (CDH). Materials and Methods: This was an IRB approved, retrospective study from 2012 to 2016. Demographic data, intraoperative analgesic regimen, total 7-day postoperative opioid consumption, and use of adjunctive pain medications were compared by surgery type (open versus MIS). Secondary measures included time to tracheal extubation, oral feeds, and discharge home. Results: The study cohort included 28 patients (13 female, median age 5 days, average gestational age 39 weeks, and weight 3 kg). MIS was performed in 8 patients. In the first 7 postoperative days, the median postoperative opioid consumption was 0.3 mg/kg of oral morphine equivalents (interquartile range [IQR] 0.2, 18.3) in the MIS group versus 32.3 mg/kg (IQR 9.9, 53.6) in the open group (95% CI of differences in medians: 8.2-42.9; P = .006). No difference was noted in intraoperative opioid administration. Among secondary outcomes, length of stay was significantly longer in the open group. Conclusions: Although several factors may impact the hospital course of neonates with CDH, we found that patients had a more than 100-fold difference in median opioid consumption following repair with MIS versus an open approach. The study also noted significant variation in analgesic regimens suggesting other avenues for improved care of postsurgical neonates.
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Affiliation(s)
- Mary J Romnek
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karen Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephani Kim
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Arlyne Thung
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Mitul AR, Sarin YK. Minimal Access Surgery in Neonates. J Neonatal Surg 2017; 6:59. [PMID: 28920019 PMCID: PMC5593478 DOI: 10.21699/jns.v6i3.614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022] Open
Abstract
Despite the significant advancement of minimally invasive surgery (MIS) in the adults and even in pediatric population, its role as the standard of care in the neonates has not yet been established among the pediatric and neonatal surgeons universally. Lots of controversies still arise though several advanced centers in the world having very experienced surgeons performing MIS for neonatal surgical conditions with promising outcomes. The unique physiological characteristics of a neonate make MIS quiet a challenging subject among these tiny babies. We have tried to look into the recent literature on the issues related to the use of MIS for the surgical management of neonates.
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Affiliation(s)
- Ashrarur Rahman Mitul
- Department of Pediatric Surgery, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Bangladesh
| | - Yogesh Kumar Sarin
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int 2016; 32:1157-1164. [PMID: 27709290 DOI: 10.1007/s00383-016-3974-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Although the principles of the Ladd's procedure for intestinal malrotation in children have remained unchanged since its first description, in the era of minimally invasive surgery it is controversial whether laparoscopy is advantageous over open surgery. The aim of our study was to determine whether the surgical approach for the treatment of malrotation had an impact on patient outcome. METHODS Using a defined strategy (PubMed, Cochrane, Embase and Web of Science MeSH headings), two investigators independently searched for studies comparing open versus laparoscopic Ladd's procedure in children. Case reports and opinion articles were excluded. Outcome measures included age at operation, time to full enteral feeding, length of hospital stay, and post-operative complications. Maneuvers were compared using Fisher's exact test and meta-analysis was conducted using RevMan 5.3. Data are expressed as mean ± SD. RESULTS Of 308 abstracts screened, 49 full-text articles were analyzed and nine (all retrospective) met our search criteria. Selected articles included 1003 patients, of whom 744 (74 %) underwent open surgery and 259 (26 %) laparoscopy. Patients who had open surgery were younger (0.9 ± 1.2 years) than those who underwent laparoscopy (2.6 ± 3 years; p < 0.0001). Laparoscopy was converted to open Ladd's in 25.3 % patients. Laparoscopy was associated with faster full enteral feeding (1.5 ± 0.3 days) in comparison to open surgery (4.6 ± 0.1 days, p < 0.0001). Length of hospital stay was shorter in the laparoscopic group (5.9 ± 4.3 days) than in the open group (11.2 ± 6.7 days; p < 0.0001). Open surgery was associated with higher overall post-operative complication rate (21 %) than laparoscopy (8 %; p < 0.0001). Although there was no difference in the prevalence of post-operative bowel obstruction (open, n = 10 %; laparoscopy, n = 0 % p = 0.07), post-operative volvulus was more frequent in the laparoscopy group (3.5 %) than in the open group (1.4 %, p = 0.04). CONCLUSION Comparative but non-randomized studies indicate that laparoscopic Ladd's procedure is not commonly performed in young children. Although one third of laparoscopic procedures is converted to open surgery, laparoscopy is associated with shorter time to full enteral feeds and length of hospital stay. However, laparoscopic Ladd's procedure seems to have higher incidence of post-operative volvulus. Prospective randomized studies with long follow-up are needed to confirm present outcome data and determine the safety and effectiveness of the laparoscopic approach.
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Fujiogi M, Tanaka Y, Kawashima H, Toma M, Suzuki K, Amano H, Morita K, Uchida H, Iwanaka T. An Easy and Safe Technique for Laparoscopic Pyloromyotomy: Using a Vascular Clamp for Stabilization of the Pylorus. J Laparoendosc Adv Surg Tech A 2015; 25:1036-9. [DOI: 10.1089/lap.2015.0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Michimasa Fujiogi
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Miki Toma
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Keisuke Suzuki
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kaori Morita
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
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García-Hernández C, Carvajal-Figueroa L, Landa-Juárez S. Selective transperitoneal aspiration of a distended bowel with a small-caliber needle during laparoscopic Nissen fundoplication: a prospective randomized controlled trial. J Laparoendosc Adv Surg Tech A 2015; 25:159-62. [PMID: 25683074 DOI: 10.1089/lap.2014.0367] [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
INTRODUCTION Anecdotal reports have demonstrated the feasibility of needle aspiration to deflate a distended bowel, but we do not know of any prospective study that has evaluated this technique. We designed a controlled study to evaluate the use of the selective transperitoneal needle aspiration of a bowel loop (STAB) in infants. MATERIALS AND METHODS Candidates were patients of less than 6 months of age, scheduled for laparoscopic Nissen fundoplication, in whom severe colonic distension was observed. We randomized the patients to the study drug or placebo in a 1:1 mode. The treatment group received STAB, whereas the control group was subject to conventional maneuvers. We performed 403 Nissen procedures laparoscopically: 102 were in infants ≤ 6 months old, but only 44 presented severe transverse colonic distension. RESULTS STAB facilitated the surgical procedure and drastically reduced surgical time. Thus, we calculated our sample size with use of the following inputs: 90% power, a critical P value of .05, and 50% reduction in surgical time. This resulted in a necessary sample size of 21 subjects per group, for a total required sample size of 42 subjects. STAB procedures were done in 23 patients, and conventional measures were used in 21. STAB was attempted a total of 45 times. Mean operative time was shorter in the STAB group. CONCLUSIONS We propose the use of STAB as alternative therapy to decompress a dilated large-bowel loop during laparoscopic surgery. This maneuver is simple and efficient and has no clinical complications. Future studies are required to evaluate its role in the subset of other patients or procedures.
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Peycelon M, Parmentier B, Raquillet C, Louvet N, Audry G, Auber F. [Video-assisted surgery in children: current progress and future perspectives]. Arch Pediatr 2013; 20:509-16. [PMID: 23566581 DOI: 10.1016/j.arcped.2013.02.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/01/2013] [Accepted: 02/24/2013] [Indexed: 01/10/2023]
Abstract
This review presents the evidence of video-assisted surgery in the pediatric population and discusses future progress in this field. Videosurgery minimizes the cosmetic impact and the pain induced by open procedures and has been in constant development in adults and children. Earlier training of surgeons and residents combined with advances in anesthetics and technology have expanded the use of videosurgery for more complex interventions. Although most feasible surgical procedures have been performed by laparoscopy, the literature has not yet defined it as the gold standard for most interventions, especially because of the lack of evidence for many of them. However, laparoscopy for cholecystectomy is now the preferred approach with excellent postoperative outcomes and few complications. Although no evidence has been demonstrated in children, laparoscopy has been shown to be superior in adults for gastroesophageal reflux disease and splenectomy. Laparoscopic appendectomy remains controversial. Nevertheless, meta-analyses have concluded in moderate but significant advantages in terms of pain, cosmetic considerations, and recovery for the laparoscopic approach. Laparoscopy is now adopted for undescended testes and allows both localization and surgical treatment if necessary. For benign conditions, videosurgery can be an excellent tool for nephrectomy and adrenalectomy. However, laparoscopy remains controversial in pediatric surgical oncology.
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Affiliation(s)
- M Peycelon
- Service de chirurgie viscérale pédiatrique et néonatale, hôpital Armand-Trousseau, hôpitaux universitaires Est Parisien, AP-HP, 26, avenue du Docteur-Arnold-Netter, 75012 Paris cedex 12, France.
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Yilmaz H, Alptekin H, Acar F, Ciftci I, Tekin A, Sahin M. Experiences of single incision cholecystectomy. Int J Med Sci 2013; 10:73-8. [PMID: 23289008 PMCID: PMC3534880 DOI: 10.7150/ijms.5030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/26/2012] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Single incision laparoscopic surgery in suitable cases is preferred today because it results in less postoperative pain, a more rapid recovery period, more comfort, and a better cosmetic appearance from smaller incisions. This study aims to present our experiences with single incision laparoscopic cholecystectomy to evaluate the safety and feasibility of this procedure. METHODS A total of 150 patients who underwent single incision laparoscopic cholecystectomy between January 2009 and December 2011 were evaluated retrospectively. In this serial, two different access techniques were used for single incision laparoscopy. RESULTS Single incision laparoscopic cholecystectomy was performed successfully on 150 patients. Median operative time was 29 (minimum-maximum=5-66) minutes. Median duration of hospital stay was found to be 1.33 (minimum-maximum=1-8) days. Patients were controlled on the seventh postoperative day. Bilier complication was not seen in the early period. Five patients showed port site hernia complications. Other major complications were not seen in the 36-month follow-up period. CONCLUSION Operation time of single incision laparoscopic cholecystectomy is significantly shortened with the learning curve. Single incision laparoscopic cholecystectomy seems a safe method.
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Affiliation(s)
- Huseyin Yilmaz
- Department of General Surgery, Selcuklu Medical School, Selcuk University, TURKEY
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Ceelie I, van Dijk M, Bax N, de Wildt S, Tibboell D. Does minimal access major surgery in the newborn hurt less? An evaluation of cumulative opioid doses. Eur J Pain 2012; 15:615-20. [DOI: 10.1016/j.ejpain.2010.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 11/07/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
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Abstract
Myasthenia gravis (MG) is a debilitating disease which necessitates long-term medical therapy. If left untreated, it can have a high mortality rate. The commonest variety in children, the autoimmune variety, often requires recourse to immunomodulation including prolonged usage of high-dose steroids. Thymectomy has not been a popular option among treating clinicians. There is evidence to suggest that if thymectomy is performed early in the disease, it has a high success rate in reducing the doses of the oral steroid medication and also in inducing remission of the disease. We have performed video-assisted thoracoscopic surgery (VATS) thymectomy in four patients with the autoimmune variety of MG. In this study, we have had a fair and comparable success rate as with the other adult series. On the basis of this preliminary study, we recommend that the option of VATS thymectomy should be offered to select patients of MG.
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Park HJ, Jeong JY, Kim KT, Choi YH. Hinge reinforcement plate for adult pectus excavatum repair: a novel tool for the prevention of intercostal muscle strip☆. Interact Cardiovasc Thorac Surg 2011; 12:687-91. [DOI: 10.1510/icvts.2010.254995] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Aggarwal SK, Sinha SK, Ratan SK, Dhua A, Pant N, Borkar N, Nirwal G. Laparoscopic or laparoscopic-assisted pelvic surgery in small infants: our experience. J Laparoendosc Adv Surg Tech A 2011; 21:543-8. [PMID: 21391829 DOI: 10.1089/lap.2010.0521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to review our experience of laparoscopic (LA) or laparoscopic-assisted pelvic surgery (LAPS) in small infants. MATERIALS AND METHODS The medical records of 35 patients who underwent an LA or LAPS between January 2007 and June 2010 were studied and 21 patients who were younger than 1 year or whose weight was less than 10 kg were included. Indications, procedures, results, and complications were analyzed. RESULTS The indications of surgery and procedures done were impalpable undescended testes (7 cases--3 single-stage orchidopexy and 4 Fowler Stephen stage I ligation of testicular vessels), Hirschsprung's disease (HD; 5 cases--all laparoscopic-assisted transanal pull-through), anorectal malformation (ARM; 3 cases--all laparoscopic-assisted pull-through), disorders of sexual differentiation (3 cases--1 herniotomy and 2 gonadal biopsy), sacrococcygeal teratoma (1 case--laparoscopic mobilization of pelvic component and posterior sagittal excision), and ovarian mass (2 cases; laparoscopic oophorectomy). There were 14 males, 4 females, and 3 of indeterminate sex. All procedures could be successfully completed without conversion. There was no anesthesia-related complication or need for postoperative ventilatory support. There were no immediate procedure-related complications. One female child with ARM had rectal mucosal prolapse; 1 HD case had rectovaginal fistula that healed following fecal diversion. The major advantages of laparoscopy in different indications were magnified access into the depth of pelvis and early frozen section biopsies in HD, accurate placement of neoanus in the center of muscle complex in ARM, early ligation of vessels and avoidance of laparotomy in sacrococcygeal teratoma, ease of decision making and better mobilization of vessels in undescended testes, and diagnostic accuracy and therapeutic procedure in ambiguous genitalia. CONCLUSION Laparoscopic pelvic surgery in small infants is a safe procedure with advantage of magnification, access, and cosmesis.
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Affiliation(s)
- Satish Kumar Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical Collage and Lok Nayak Hospital, New Delhi, India.
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The role of laparoscopy in the management of adnexal lesions in children. Surg Laparosc Endosc Percutan Tech 2011; 19:514-7. [PMID: 20027099 DOI: 10.1097/sle.0b013e3181c3132e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Laparoscopy has replaced laparotomy in a variety of surgical abdominal conditions. In pediatric patients the vast majority of adnexal lesions are benign. The aim of this study was to assess the safety and feasibility of laparoscopy in adnexal pathology in children. MATERIALS AND METHODS The case notes of girls with confirmed adnexal disorders treated in a single center between 1998 and 2008 were reviewed retrospectively. Demographic data, clinical and imaging features, surgical findings and procedures, pathologic features, complications, and outcomes were recorded. RESULTS Over a 10-year-period 21 patients underwent laparoscopic surgery. Median age at operation was 14 years (range: 2 d to 16 y). Laparoscopy was diagnostic in 1 patient whereas it was therapeutic in 14; 2 patients underwent a laparoscopy-assisted minilaparotomy. The procedure was converted to open in 4 patients due to technical difficulties. The most commonly performed procedures laparoscopically were cyst aspiration (n=6), cystectomy (n=4), unilateral oophorectomy (n=2), and cyst aspiration with deroofing (n=2). No operative or postoperative complications occurred. The overall mean postoperative length of stay was 2.3 days (range: 1 to 6 d); it was 1.8 days (range: 1 to 3 d) for patients who had laparoscopic procedures. Pathology revealed benign lesions in all cases. CONCLUSIONS In children with benign adnexal pathology, minimally invasive surgery is a feasible and safe approach. Additional benefits of shorter hospital stay, superior cosmetic result, and lesser risk of infertility, make laparoscopy a method of choice for managing pediatric patients.
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Kim T, Kim DY, Cho MJ, Kim SC, Seo JJ, Kim IK. Use of laparoscopic surgical resection for pediatric malignant solid tumors: a case series. Surg Endosc 2010; 25:1484-8. [DOI: 10.1007/s00464-010-1418-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 08/29/2010] [Indexed: 10/18/2022]
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Minimally invasive repair of pectus excavatum: a novel morphology-tailored, patient-specific approach. J Thorac Cardiovasc Surg 2010; 139:379-86. [PMID: 20106400 DOI: 10.1016/j.jtcvs.2009.09.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 08/08/2009] [Accepted: 09/08/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Minimally invasive repair of pectus excavatum, introduced by Nuss in 1998, has undergone a serious learning curve because of a lack of understanding on morphologies and repair techniques. To summarize the current status of minimally invasive repair of pectus excavatum, we reviewed and appraised our 10-year experience with a novel approach, a morphology-tailored technique, including diverse bar shaping, bar fixation, and techniques for adults. METHODS We analyzed the data of 1170 consecutive patients with pectus excavatum who underwent minimally invasive repair between August 1999 and September 2008. All pectus repairs were performed by the primary author (H.J.P.) with our modified technique. RESULTS The mean age was 10.3 years (range, 16 months to 51 years). There were 331 adult patients (>15 years) (28.3%). A total of 576 patients (49.2%) had bar removal after a mean of 2.5 years (range, 10 days to 7 years). The asymmetry index change (1.10-1.02, P < .001) demonstrated post-repair symmetry. Complication rates decreased through the 3 time periods (1999-2002 [n = 335]; 2003-2005 [n = 441]; 2006-2008 [n = 394]) as follows: pneumothorax rate (7.5% vs 4.3% vs 0.8%; P < .001) and bar displacement rate (3.8% vs 2.3% vs 0.5%; P = .002). Reoperation rate also decreased (4.8% vs 2.5% vs 0.8%; P = .002). Satisfaction outcomes were excellent in 92.7%, good in 5.9%, and fair in 1.4% of patients. After bar removal, 3 patients (0.6%) had minor recurrences. CONCLUSION Minimally invasive repair of pectus excavatum based on a novel morphology-tailored, patient-specific approach is effective for quality repair of the full spectrum of pectus excavatum, including asymmetry and adult patients. Continuous technical refinements have significantly decreased the complication rates and postoperative morbidity.
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Metzelder ML, Kuebler JF, Huber D, Vieten G, Suempelmann R, Ure BM, Osthaus WA. Cardiovascular responses to prolonged carbon dioxide pneumoperitoneum in neonatal versus adolescent pigs. Surg Endosc 2009; 24:670-4. [DOI: 10.1007/s00464-009-0654-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 06/25/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022]
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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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