A new technique applicable to pediatric laparoscopic surgery: abdominal wall 'area lifting' with subcutaneous wiring

Gasless laparoscopy revisited in the SARS-CoV-2 pandemic

Reluctance towards general acceptance of gasless laparoscopic surgery has been mainly due to reservations on whether these techniques would create a greater extent of pain and surgical stress at the targeted site of abdominal wall lifting, and also whether the operating space achieved would be sufficient for the scope to be maneuvered effectively and safely in the abdominal cavity. With the widespread mortality in patients infected by SARS-CoV-2, the most relevant gasless endoscopic techniques have been revisited to explore options in performing endoscopic procedures, especially in children with more safety by reducing aerosolized viral contamination.

Hanger-lifting procedure in knee arthroscopy

We propose a unique arthroscopic technique, the "hanger-lifting procedure." Unlike conventional arthroscopy, the space in which the arthroscope is placed is not a joint space filled with water but a subcutaneous space filled with air. The space is kept lifted by a semi-loop-shaped hanger and a retraction system by use of a wire. In general, arthroscopes are unable to be applied outside the joint because of the lack of a cavity. However, this method can provide extra-articular visualization of the knee in addition to standard intra-articular visualization. This approach is useful for lateral release of the knee extensor and bipartite patellae, allowing direct vision from both outside and inside the joint. One possible complication is subcutaneous effusion or interstitial edema. Compressive dressings should be applied to prevent subcutaneous effusion after surgery. However, the combination of conventional arthroscopy by use of saline solution and the hanger-lifting technique by use of air arthroscopy can provide an excellent view inside and outside the joint. This technique may continue to evolve, and although some points in the technique can be improved, this method is useful in joint surgeries.

Current concepts in minimal access surgery for children

Since the introduction of minimal access surgery to general surgeons in the 1980s, pediatric surgeons have been employing this innovative technology to perform surgery on children. Video technology and miniaturized instruments have brought the laboratory to the operating room; in many cases several small incisions are the only access necessary to perform complicated procedures that would otherwise require a large wound. Additional benefits of minimal access surgery may include reduced postoperative analgesic requirements, shortened length of stay, and faster resumption of normal activities. Increased operative costs offset some of these gains. The pediatric surgical community has embraced minimal access techniques for some operations; others remain controversial.

Laparoscopy in pediatric urology

Laparoscopy in pediatric urology is a rapidly evolving field that is becoming part of the operative repertoire of an increasing number of pediatric urologists. This article summarizes the latest ideas and issues in the expanding field of laparoscopy in pediatric urology. New methods of obtaining laparoscopic access and retraction are discussed. Laparoscopic experiences in urologic reconstruction, diagnosis and treatment of the nonpalpable testis, renal surgery, ureteral reimplantation, varicocelectomy, hydrocelectomy, and herniorrhaphy are reviewed. Articles assessing the safety of a pneumoperitoneum in patients with a ventriculoperitoneal shunt are also discussed.

Institutional Review Board approval for prospective experimental studies on infants and children

BACKGROUND/PURPOSE

The Declaration of Helsinki requires Institutional Review Board (IRB) approval for experimental studies on human subjects. The authors questioned whether published prospective surgical experimental studies document IRB approval for infants and children.

METHODS

Prospective studies were identified in 5 surgical and 2 major pediatric journals from 1997 through 1999. Documentation of IRB approval was recorded. Results were analyzed using Pearson chi(2) tests and a multivariate regression model. Statistical significance was defined as P less than .05.

RESULTS

A total of 149 prospective experimental studies on pediatric subjects were evaluated; the majority being interventional or therapeutic studies (105 of 149). More than 75% were from academic medical centers (125 of 149), grant-supported (110 of 149), and appeared in surgical journals (110 of 149). Slightly less than 25% of studies (40 of 149) documented IRB approval. Observational studies, grant support, and publication in nonsurgical journals all correlated positively with IRB approval and were statistically significant variables (P<.001, P<.001, P<.001, respectively). Interventional or therapeutic, institutionally or privately-funded studies found in surgical journals were most likely to avoid IRB documentation (P<.001).

CONCLUSIONS

The majority of prospective pediatric studies in the surgical journals omit IRB documentation. Strict requirements for specific IRB approval and documentation in compliance with the Declaration of Helsinki would allow higher ethical standards for the clinical investigation of infants and children.