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Agrawal V, Tiwari A, Sharma D, Mishra R, Acharya H. Comparison of 3D vs 2D laparoscopic-assisted anorectal pull-through (LAARP) for high anorectal malformations in children. Asian J Endosc Surg 2021; 14:424-431. [PMID: 33145992 DOI: 10.1111/ases.12885] [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: 08/17/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The limitation of two-dimensional (2D) laparoscopic techniques includes lack of stereoscopic vision and depth perception which can affect surgical performance, physical and mental comfort of the operating surgeon. 3D laparoscopic surgery is popular in adults; however, its application and experience in the pediatric age group have been limited. We did a comparison of 2D and 3D laparoscopic-assisted anorectal pull-through (LAARP) in male high anorectal malformations (ARM). MATERIAL AND METHOD This prospective cohort study included male children diagnosed with high anorectal malformation (recto-prostatic urethral fistula) who underwent LAARP in infancy after a neonatal colostomy between November 2019 to March 2020. The patients were randomized into a 2D group or 3D group at a 1:1 ratio. Patient demographics and operative/postoperative parameters were recorded. The effect of 3D laparoscopy was assessed in terms of laparoscopy visual parameters (image quality, depth perception, hand-eye coordination, and precision), physical discomfort (5-point Likert scale), and mental strain (State-Trait Anxiety Inventory scale). The statistical tests were performed on SPSS version 16. RESULTS The demographics of both groups, 20 (patients in each), were similar. There was a significant reduction of laparoscopy execution time, physical discomfort (for eye, hand and wrist strain), and overall mental strain in the 3D group. There were similar complications, blood loss, and hospital stay, and no open conversion in two groups. CONCLUSION 3D LAARP is feasible and safe in the surgical treatment of ARM in children. Further studies with assessment by more than one observer are needed to investigate the wider application of 3D in pediatric surgery.
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Affiliation(s)
- Vikesh Agrawal
- Pediatric Surgery Division; Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, India
| | - Abhishek Tiwari
- Pediatric Surgery Division; Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, India
| | - Dhananjaya Sharma
- Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | - Rajesh Mishra
- Pediatric Surgery Division; Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, India
| | - Himanshu Acharya
- Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
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丁 光, 程 嗣, 方 冬, 杨 昆, 李 学, 周 辉, 张 骞, 叶 雄, 周 利. [Review of upper urinary modified minimal invasive surgical technology]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:610-614. [PMID: 31420609 PMCID: PMC7433496 DOI: 10.19723/j.issn.1671-167x.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 11/20/2022]
Abstract
Upper urinary surgery is an important area of urology surgery. Open surgery used to be the gold standard of upper urinary surgery. With the development of medical techniques, minimal invasive surgeries including laparoscopic and robot assisted-laparoscopic surgery have gradually replaced the open surgery. Because of the complexity and diversity of upper urinary diseases, surgeries sometimes are difficult, and minimal invasive surgeries require higher surgical abilities of urologists than open surgeries. In recent years, depending on our surgical experience and international reports, our team from three Chinese medical centers summarizes techniques of upper urinary minimal invasive surgeries. For malignant diseases, such as renal and ureteral carcinomas, it's important to totally remove the tumor first, and then to avoid the surgical injuries. We summarize surgical experience of retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors. Our team modified minimal invasive techniques for some complex tumors, including ring suture technique for renal hilar tumors, internal suspension technique for renal ventral tumors, and combination retroperitoneal laparoscopic surgery with mini-flank incision for complex renal tumors. While for begin diseases, urologists should focus on the resections and surgical injuries at the same time. We have reported the novel technique of laparoscopic aspiration for central renal angiomyolipoma, making the surgery simple and available. For reconstruction surgeries, operations should be based on several principals. We generalize it as "4TB principals", which include "tension-free", "water-tight", "thin suture", "no touch of the key area" and "protecting the blood supply". Depending on the localization, length, and etiology of the strictures, different techniques are required. Our team summarize the pyeloplasty, ureteral reimplantation and ileal ureter replacement based on our surgical experience. For infant upper urinary surgeries, our team has made invasive surgeries that can be used in complex diseases, such as duplex kidney. Based on years of surgical techniques, our modified surgeries achieve a better subjective cosmetic result than the traditional surgeries. In the future, the standardized, practical, simple and individual minimal invasive surgical technique will become the main direction in the future researches.
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Affiliation(s)
- 光璞 丁
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 嗣达 程
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 冬 方
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 昆霖 杨
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 学松 李
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 辉霞 周
- 中国人民解放军总医院第七医学中心八一儿童医院泌尿外科, 北京 100700Department of Pediatric Urology, Bayi Children’s Hospital Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, No 5 Nanmencang, Beijing, 100700, China
| | - 骞 张
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - 雄俊 叶
- 北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 利群 周
- 北京大学第一医院泌尿外科, 北京 100034Department of Urology, Peking University First Hospital, Beijing 100034, China
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Escolino M, Turrà F, Settimi A, Esposito C. Training for MIS in pediatric urology: proposition of a structured training curriculum. Transl Pediatr 2016; 5:315-323. [PMID: 27867857 PMCID: PMC5107368 DOI: 10.21037/tp.2016.09.07] [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] [Indexed: 11/06/2022] Open
Abstract
In Europe there are a lot of training centers for minimally invasive surgery (MIS) but a standardized MIS training program in pediatric urology doesn't exist at the moment. We performed a literature review with the last goals to propose a structured training curriculum in MIS urology for pediatric surgeons. Pediatric urologists have to obtain a valid MIS training curriculum completing the following 4 steps: (I) Theoretical part (theoretical courses, masterclass) to acquire theoretical knowledge; (II) experimental training (simulation on pelvic trainer, virtual reality simulators, animal models, 3-D ex-vivo models) to acquire basic laparoscopic skills; (III) stages in European centers of reference for pediatric MIS urology to learn all surgery aspects; (IV) personal operative experience. At the end of the training period, the trainee would be expected to perform several MIS urological procedures independently, under supervision of an expert tutor. At the end of the training program, each center will analyze the candidate training booklet and release for each applicant a certification after an exam. We think that this MIS training program in pediatric urology may assure an integrated acquisition of basic and advanced laparoscopic skills during residency training in pediatric urology. Each European country should adopt this program so as to secure a standardized technical qualification in MIS urology for all future pediatric urologists.
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Affiliation(s)
- Maria Escolino
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Francesco Turrà
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Alessandro Settimi
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
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Symeonidis EN, Nasioudis D, Economopoulos KP. Laparoendoscopic single-site surgery (LESS) for major urological procedures in the pediatric population: A systematic review. Int J Surg 2016; 29:53-61. [PMID: 27000720 DOI: 10.1016/j.ijsu.2016.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/06/2016] [Accepted: 03/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Improvements in laparoscopic surgery have led to the introduction of laparoendoscopic single-site surgery (LESS) as an alternative to conventional laparoscopy conferring a number of possible advantages. In this review, we aim to elucidate the aspects of LESS for major urological procedures in the pediatric population. MATERIALS AND METHODS An in-depth search of the literature was performed in the databases of PubMed and Scopus, for studies investigating the technical aspects and clinical outcomes of partial nephrectomies, nephrectomies, nephroureterectomies, varicocelectomies and pyeloplasties in children. Data on parameters such as operation time, instrumentation, perioperative complications, hospital stay and follow up period were collected and further analyzed cumulatively. RESULTS Twenty nine studies met the inclusion criteria incorporating 386 patients who underwent 401 procedures. There were no major intraoperative complications, with only 19 patients (4.73%) facing postoperative complications. No perioperative deaths were reported. CONCLUSIONS In the hands of experienced surgeons LESS seems a feasible, efficient and less invasive alternative to standard laparoscopy in the field of pediatric urology. There is an eminent need of well-designed randomized controlled trials comparing the two techniques.
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Affiliation(s)
- Evangelos N Symeonidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Schroeder RPJ, Chrzan RJ, Klijn AJ, Kuijper CF, Dik P, de Jong TPVM. Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre. J Pediatr Urol 2015; 11:271.e1-6. [PMID: 26096439 DOI: 10.1016/j.jpurol.2015.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. OBJECTIVE To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). STUDY DESIGN The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. RESULTS Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. DISCUSSION There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. CONCLUSION Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential.
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Affiliation(s)
- R P J Schroeder
- Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
| | - R J Chrzan
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - A J Klijn
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands.
| | - C F Kuijper
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - P Dik
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands.
| | - T P V M de Jong
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands.
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Zhou H, Ming S, Ma L, Wang C, Liu X, Zhou X, Xie H, Tao T, Ma S, Cheng W. Transumbilical single-incision laparoscopic versus conventional laparoscopic upper pole heminephroureterectomy for children with duplex kidney: a retrospective comparative study. Urology 2014; 84:1199-204. [PMID: 25443934 DOI: 10.1016/j.urology.2014.07.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/13/2014] [Accepted: 07/22/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To present our experience regarding transumbilical single-incision laparoscopic heminephroureterectomy (SILH) in children with duplex kidney anomalies, and to investigate its feasibility and safety compared with those of conventional laparoscopic heminephroureterectomy (CLH). MATERIALS AND METHODS A matched-pair study comparing 34 SILHs and 34 CLHs performed by a single surgeon from 2007 to 2013 was presented. All SILHs were performed through a 2-cm periumbilical incision by using the port-access system, whereas CLH cases were performed via a transperitoneal 3-port approach. The groups were matched for age, gender, weight, laterality, and surgical indication of the patients. Data including demographics and perioperative and short-term outcomes of the patients were retrospectively compared. RESULTS The 2 groups were comparable in demographics, and surgical indications of the patients (P >.05). No significant difference was observed between SILH and CLH cases in terms of median operative time (105 vs 97 minutes; P = .06), estimated blood loss (22 vs 25 mL; P = .91), interval for oral intake (12 vs 12 hours; P = .69), analgesic requirement (9 vs 6 cases; P = .38), transfusion rate (0% for both; P = 1.00), complication rate (2.9% vs 0%; P = 1.00), postoperative hospital stay (5.0 vs 4.5 days; P = .59), and renal functional loss of the operated side at 3 months after surgery (5.4% vs 5.2%; P = .60). CONCLUSION SILH is feasible and safe in the hands of an experienced pediatric laparoscopic surgeon. Although the outcomes were comparable, better subjective cosmetic results of SILH were achieved.
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Affiliation(s)
- Huixia Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China.
| | - Shaoxiong Ming
- The Second Military Medical University, Shanghai, People's Republic of China
| | - Lifei Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Chao Wang
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Xin Liu
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Xiaoguang Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Huawei Xie
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Tian Tao
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Sichao Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Wei Cheng
- Department of Paediatrics, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Department of Surgery, Beijing United Family Hospital, Beijing, People's Republic of China
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Rabah D, Abumostafa N, Sulaihim A, Arafa M. Survey of urologic laparoscopic practice patterns in Saudi Arabia. J Endourol 2010; 24:1293-5. [PMID: 20629567 DOI: 10.1089/end.2010.0007] [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
BACKGROUND AND PURPOSE Laparoscopic surgery is taking a greater role in the management of many urologic diseases. We performed a survey whose aim was to define laparoscopic practice patterns among urologists in Saudi Arabia. MATERIALS AND METHODS In March 2009, detailed questionnaires about urologic laparoscopic practice patterns were distributed to 352 urologists who were working in Saudi Arabia. The questions related to age, residency training, and amount of laparoscopy performed. RESULTS The overall response rate was 42%. A total of 21% of certified urologists in Saudi Arabia performed no laparoscopy, 24.8% devoted less than 5% of their practice time, and 54.3% devoted 5% or more of their practice time to laparoscopic surgery. Of the respondents, 27.5% stated that they had adequate training during residency to perform laparoscopy. Both age and time in practice were inversely related to the amount of time devoted to laparoscopy (P = 0.001). Of those who were affiliated with a university, 70% devoted more than 5% of their operative time to laparoscopy. Urologists in the Ministry of Health were the least to perform a significant volume of laparoscopy. The two most important reasons mentioned for performing laparoscopy were a faster recovery period and reduced morbidity. The main laparoscopic procedures, according to the proportion of urologists who perform laparoscopic surgery, were varicocelectomy, 38%; simple nephrectomy, 27%; renal cyst decortications, 23%; adrenalectomy, 20%; radical nephrectomy, 20%; pyeloplasty, 18%; and orchidopexy, 17%. CONCLUSIONS Urologic laparoscopic practice in Saudi Arabia is still in its early stages. Accordingly, more laparoscopic procedures should be implemented in the local training programs.
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Affiliation(s)
- Danny Rabah
- Division of Urology, Department of Surgery, King Khalid University Hospital, College of Medicine, and Princess Johora Al-Ibrahim Centre for Cancer Research, King Saud University, Riyadh, Saudi Arabia.
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Lee DJ, Kim PH, Koh CJ. Current trends in pediatric minimally invasive urologic surgery. Korean J Urol 2010; 51:80-7. [PMID: 20414418 PMCID: PMC2855486 DOI: 10.4111/kju.2010.51.2.80] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/12/2010] [Indexed: 12/12/2022] Open
Abstract
Over the past two decades, laparoscopic and robotic surgery in children has been described as a viable minimally invasive alternative to open surgery for many pediatric urologic conditions. With the goal of reducing the morbidity associated with open surgery, minimally invasive surgery in children is increasingly being performed as laparoscopic and robotic patients appear to be experiencing shorter hospital stays, decreased pain medication requirements, and the potential for improved cosmesis. This article provides an overview of the existing literature in laparoscopic and robotic-assisted laparoscopic urologic surgery in children. Laparoscopic and robotic-assisted laparoscopic surgery appears to be safe and effective in children for a wide range of ablative and reconstructive procedures. Conventional laparoscopic surgery is effective for ablative procedures, while robotic surgery may be ideally suited for reconstructive cases requiring advanced suturing and dissection. Overall, more prospective studies are needed to study the long-term outcomes of minimally invasive surgery in pediatric patients, and the appropriate use of the available technology.
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Affiliation(s)
- Dennis J Lee
- Department of Pediatric Urology, Childrens Hospital Los Angeles, University of Southern California (USC) Institute of Urology, Keck School of Medicine, USC, Los Angeles, California, USA
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