1
|
Bindi E, Nino F, Pierangeli F, Ilari M, Bollettini T, Chiarella E, Mariscoli F, Gentilucci G, Cruccetti A, Cobellis G. Transumbilical laparoscopic-assisted appendectomy <em>versus</em> laparoscopic appendectomy in children: a single center experience. Pediatr Med Chir 2023; 45. [PMID: 37114377 DOI: 10.4081/pmc.2023.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
Laparoscopic Appendectomy (LPSA) is the first choice for appendectomy in pediatric surgery. Trans-Umbilical Laparoscopic Assisted Appendicectomy (TULAA) is another used technique. We compared both these procedures used for the treatment of acute appendicitis. The study was conducted between January 2019 to December 2020. Patients were divided into two groups: LPSA and TULAA groups. The collected data were: operative time, number of conversions, time of canalization and hospital stay. A total of 181 patients were included: 73 were kept in the LPSA and 108 in the TULAA group. Mean operative time was 70.9 minutes (range 45-130 min) for LPS and 56.4 (30-145 min) for TULAA group (p <0.0001). Complications rate showed no statistically significant difference between both the two groups. However, conversions showed a statistically significant difference (p=0.04). Both techniques showed similar results. TULAA technique takes a significantly shorter operating time. The selection between LPSA and TULAA techniques depends on the experience of the surgeon's work and the personal laparoscopic learning curve. In our experience LPSA was a useful technique to improve the laparoscopic skill of the pediatric surgery residents.
Collapse
Affiliation(s)
- Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy; Università Politecnica of Marche, Ancona.
| | - Fabiano Nino
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona.
| | | | - Michele Ilari
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona.
| | | | | | | | | | - Alba Cruccetti
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona.
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy; Università Politecnica of Marche, Ancona.
| |
Collapse
|
2
|
Angotti R, Raffaele A, Molinaro F, Riccipetitoni G, Chiesa PL, Lisi G, Mattioli G, Alberti D, Boroni G, Mariscoli F, Martino A, Pelizzo G, Maffi M, Messina M, Lima M. Rise of pediatric robotic surgery in Italy: a multicenter observational retrospective study. Ann Pediatr Surg 2022. [DOI: 10.1186/s43159-021-00144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The minimally invasive surgery (MIS) in term of robot-assisted surgery changed in a dramatic way the surgical approach either in adults or children. For many specialties (urology, gynecology, general surgery) robotic surgery rapidly became the gold standard for some procedures, while the experience in pediatric population is not wide for some reasons. The aim of this study is to retrospective analyze trends of application of robotic surgery in pediatric patients across the country, focusing on indications, limitations, development, and training acquired by national experience and in comparison to the literature.
Methods
We made a retrospective multicenter study on behalf of Italian Society of Pediatric Surgery. We performed a census among all pediatric surgery units in the country to enroll those performing robotic surgery on children between 2013 and 2019.
Results
We enrolled 7 pediatric surgery referral Centers (Ancona, Bologna, Brescia, Genova, Pavia, Pescara, Siena). A total of 303 patients were included in the study, 164 males (54%) and 139 females (46%). The most commonly performed interventions for each anatomic area were respectively atypical pulmonary resection (38%), pyeloplasty (49%), and fundoplication (30%).
Conclusions
Since its first application in Italy, about 10 years ago, several considerations were made about application and feasibility of robotics in children.
Collapse
|
3
|
Cerchia E, Noviello C, Torino G, Bindi E, Mariscoli F, Cobellis G. Thoracoscopic excision of asymptomatic antenatally diagnosed mediastinal bronchogenic cysts: A case report. Pediatr Med Chir 2021; 43. [PMID: 34148340 DOI: 10.4081/pmc.2021.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/04/2021] [Indexed: 11/23/2022] Open
Abstract
Bronchogenic Cysts (BCs) are benign congenital malformations commonly located in the mediastinum. In recent years the development of antenatal diagnosis has changed the BCs management allowing an earlier minimally invasive approach. We report a case of an asymptomatic 8-months-old girl with antenatal diagnosis of subcarinal posterior mediastinal BC. Thoracoscopic excision of the cyst was successfully performed. The management of antenatally diagnosed BCs is discussed. Thoracoscopic treatment of BCs is safe and effective with the advantage of a reduced morbidity compared to thoracotomy.
Collapse
Affiliation(s)
- Elisa Cerchia
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona.
| | - Carmine Noviello
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona.
| | - Giovanni Torino
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona.
| | - Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona.
| | - Francesca Mariscoli
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona.
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona.
| |
Collapse
|
4
|
Torino G, Adorisio O, Cobellis G, Mariscoli F, Zaccara A. Robotic Excision of the Vagina in a 46 XX DSD Male Patient. First Pediatric Report. Urol J 2021; 18:466-468. [PMID: 33840088 DOI: 10.22037/uj.v18i.6470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Disorders of Sex Differentiation (DSD) represent a wide range of congenital anomalies of the genitalia. Surgical treatment of these cases may become a challenge. We present a case of a 16-year-old boy with 46 XX DSD, SRY negative, presented with persistent dribbling incontinence, recurrent UTI and perineal pain. Past medical history included right orchiectomy, laparoscopic excision of uterus, fallopian tubes and left streak gonad at another institution at the age of 2 years. The native vagina was left in place. VCUG confirmed the presence of the residual vagina (8 cm in maximum length), connected with the bulbar urethra. Robotic-assisted laparoscopy of the vagina was performed with satisfying short and long-term results.
Collapse
Affiliation(s)
- Giovanni Torino
- Pediatric Urology Unit, "Santobono-Pausilipon" Children's Hospital, Naples (Italy).
| | - Ottavio Adorisio
- Department of Pediatric Surgery, Pediatric Surgery Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy.
| | - Giovanni Cobellis
- Pediatric Surgery and Urology Unit, "G. Salesi" Children's Hospital, Marche Polytechnic University, Ancona, Italy.
| | - Francesca Mariscoli
- Pediatric Surgery and Urology Unit, "G. Salesi" Children's Hospital, Marche Polytechnic University, Ancona, Italy.
| | - Antonio Zaccara
- Department of Pediatric Surgery, Pediatric Urology and Urodynamics Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro, Rome, Italy.
| |
Collapse
|
5
|
Scarcella S, Tiroli M, Torino G, Mariscoli F, Cobellis G, Galosi AB. Combined treatment of ureteropelvic junction obstruction and renal calculi with robot-assisted laparoscopic pyeloplasty and laser lithotripsy in children: Case report and non-systematic review of the literature. Int J Med Robot 2021; 17:e2246. [PMID: 33626232 DOI: 10.1002/rcs.2246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE(S) The incidence of urinary tract stone disease is steadily increasing in both adult and paediatric populations. This condition develops due to different factors: dietary or metabolic alterations, infection, and congenital anatomic malformations. Standard indications and treatments for children are analogous to the ones indicated for adults. Extracorporeal shock wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy (PCNL) should be preferred to more invasive techniques. Moreover, the introduction of laparoscopic and robot-assisted laparoscopic approaches have improved surgical outcomes, lowering the bleeding risk with higher stone-free rates, even in complicated cases. Despite these well-known improvements, there are few reports regarding laparoscopic robot-assisted management for urinary tract stone disease in paediatric patients under the age of 10, especially with concomitant treatment of ureteropelvic junction obstruction and multiple calyceal stones. PATIENT AND METHOD(S) A 4-year-old child was referred for recurrent right abdominal flank pain, macroscopic haematuria and a previous history of urinary tract infections. A computed tomography of the abdomen showed right ureteropelvic junction obstruction associated with multiple unilateral stones located in the renal pelvis and in the interpolar renal calyces. Due to its complexity, we held a multidisciplinary meeting with paediatric surgeons and nephrologists to determine optimal treatment. As a result, a combined robot-assisted laparoscopic pyeloplasty (LP) and renal calculi holmium laser lithotripsy using a digital flexible ureteroscope through an abdominal robotic trocar was performed. No post-surgical complications were recorded, and the patient was discharged within 48 h following surgery. At subsequent regular follow-up examinations over a period of 24 months, no signs of recurrence were detected for both ureteropelvic junction obstruction and stone disease. RESULT(S) Robot-assisted LP with concomitant laser lithotripsy is a reasonable treatment option for designated young paediatric patients with challenging ureteropelvic junction obstruction complicated by urolithiasis, especially in cases where stones are not amenable with standard procedures.
Collapse
Affiliation(s)
- Simone Scarcella
- Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy
| | - Marco Tiroli
- Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy
| | - Giovanni Torino
- Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Francesca Mariscoli
- Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital and "G. Salesi" Children's Hospital, Ancona, Italy
| | - Andrea Benedetto Galosi
- Department of Urology, Polytechnic University of Marche Region, "Ospedali Riuniti" Hospital, Ancona, Italy
| |
Collapse
|
6
|
Bindi E, Cruccetti A, Ilari M, Mariscoli F, Carnielli VP, Simonini A, Cobellis G. Meckel's diverticulum perforation in a newborn positive to Sars-Cov-2. J Pediatr Surg Case Rep 2020; 62:101641. [PMID: 32904556 PMCID: PMC7456189 DOI: 10.1016/j.epsc.2020.101641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 01/10/2023] Open
Abstract
The health emergency linked to the Sars-Cov-2 infection represented an absolutely new problem for all health professionals. In particular, the information regarding the spread of the virus in the pediatric field and its manifestations are still incomplete. In this paper we present a case of neonatal infection which, as far as we know, represents one of the few published cases and which occurred in a patient who came to our attention for acute abdomen from intestinal perforation. The perforation was caused by Meckel's diverticulum, an event considered infrequent in the first year of life and almost exceptional in the neonatal period. This case required particular management, putting pediatric surgeons in front of new and difficult to solve problems. New onset clinical events, such as this one described, represent an opportunity for sharing useful data for the creation of universal protocols for the management of patients with problems that are becoming common and of which little is known.
Collapse
Affiliation(s)
- E Bindi
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
| | - A Cruccetti
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
| | - M Ilari
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
| | - F Mariscoli
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
| | - V P Carnielli
- Neonatology Unit, Salesi Children's Hospital, Ancona, Italy
- University Politecnica delle Marche, Ancona, Italy
| | - A Simonini
- Pediatric Intensive Care Unit, Salesi Children's Hospital, Ancona, Italy
| | - G Cobellis
- Pediatric Surgical Unit, Salesi Children's Hospital, Ancona, Italy
- University Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
7
|
Noviello C, Romano M, Nino F, Rossi M, Nobile S, Mariscoli F, Martino A, Cobellis G. Delayed diagnosis of hirschsprungs disease after esophageal atresia repair. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
8
|
Cobellis G, Nino F, Pierangeli F, Mariscoli F, Noviello C, Martino A. Retroperitoneoscopic One-Trocar-Assisted Pyeloplasty in Children: An Age-Related Evaluation. J Laparoendosc Adv Surg Tech A 2017; 27:651-654. [DOI: 10.1089/lap.2016.0457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Fabiano Nino
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Pierangeli
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Francesca Mariscoli
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Carmine Noviello
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Ascanio Martino
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
9
|
Angotti R, Molinaro F, Sica M, Mariscoli F, Bindi E, Mazzei O, Ferrara F, Messina M. Association of Duodenal Atresia, Malrotation, and Atrial Septal Defect in a Down-Syndrome Patient. APSP J Case Rep 2016; 7:16. [PMID: 27170921 PMCID: PMC4852059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022] Open
Abstract
Duodenal atresia is the frequent cause of neonatal intestinal obstruction. The association between duodenal atresia, intestinal malrotation, cardiac anomalies and Down syndrome is infrequently reported. We present a prenatally suspected case of duodenal atresia which was associated with malrotation and atrial septal defect in a patient of Down syndrome. Duodenotomy and resection of web was performed in addition to Ladd's procedure. Postoperative course remained uneventful.
Collapse
|
10
|
Molinaro F, Ferrara F, Cerchia E, Brandigi E, Angotti R, Mariscoli F, Messina M. Rectal duplication cyst in previous anorectal malformation and Down syndrome. Minerva Pediatr 2015; 67:454-456. [PMID: 26377786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- F Molinaro
- Department of Medical Sciences, Surgery and Neurosciences, Clinic Pediatric Surgery, University of Siena, Siena, Italy -
| | | | | | | | | | | | | |
Collapse
|
11
|
Noviello C, Romano M, Mariscoli F, De Benedictis FM, Martino A, Cobellis G. Esophageal multichannel intraluminal impedance and pH monitoring in children: indications and limits. Minerva Pediatr 2014; 66:287-291. [PMID: 25198565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Aim of the study was to compare multichannel intraluminal impedance (MII)-pH monitoring versus pH only, as first-line assessment of gastroesophageal reflux (GER) in children and to define the relation between GER and symptoms as well relation between types of GER and age of children. METHODS All the patients with GER were divided in three groups: A, younger than 24 months, B, older than 24 months with typical symptoms and C, older than 24 months with atypical symptoms. The groups A and C underwent a combined MII-pH recording. The group B underwent a only pH recording. MII-pH measurements were performed in 89 children (63 group A and 26 group C), only pH measurements in 170 cases (group B). RESULTS Sixty-seven of the 247 pH measurements demonstrated abnormal reflux indices: 25.0% (group A), 28.8% (group B) and 20.8% (group C). The number of the reflux periods and the total reflux index were highest in the patients of the group B, but the number of long reflux periods was highest in the group C. Abnormal values at MII results were found in 36 cases: 41.7% in group A (high number of weakly acid refluxes events) and 45.8% in group C (similar number of acid and weakly acid events). The MII were considered pathological because of high number of reflux episodes and symptom index ≥ 50% respectively in 60.0% and 40.0% of the group A and 27.3% and 62.7% of the group C. CONCLUSION MII-pH study must be reserved to patients younger than 2-year old (high probability of weakly acid reflux) and children with atypical symptoms.
Collapse
Affiliation(s)
- C Noviello
- Pediatric Surgery Unit, Salesi Children Hospital Ospedali Riuniti Ancona, Ancona Italy -
| | | | | | | | | | | |
Collapse
|
12
|
Cobellis G, Noviello C, Nino F, Romano M, Mariscoli F, Martino A, Parmeggiani P, Papparella A. Spermatogenesis and cryptorchidism. Front Endocrinol (Lausanne) 2014; 5:63. [PMID: 24829558 PMCID: PMC4013472 DOI: 10.3389/fendo.2014.00063] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/14/2014] [Indexed: 12/24/2022] Open
Abstract
Cryptorchidism represents the most common endocrine disease in boys, with infertility more frequently observed in bilateral forms. It is also known that undescended testes, if untreated, lead to an increased risk of testicular tumors, usually seminomas, arising from mutant germ cells. In normal testes, germ cell development is an active process starting in the first months of life when the neonatal gonocytes transform into adult dark (AD) spermatogonia. These cells are now thought to be the stem cells useful to support spermatogenesis. Several researches suggest that AD spermatogonia form between 3 and 9 months of age. Not all the neonatal gonocytes transform into AD spermatogonia; indeed, the residual gonocytes undergo involution by apoptosis. In the undescended testes, these transformations are inhibited leading to a deficient pool of stem cells for post pubertal spermatogenesis. Early surgical intervention in infancy may allow the normal development of stem cells for spermatogenesis. Moreover, it is very interesting to note that intra-tubular carcinoma in situ in the second and third decades have enzymatic markers similar to neonatal gonocytes suggesting that these cells fail transformation into AD spermatogonia and likely generate testicular cancer (TC) in cryptorchid men. Orchidopexy between 6 and 12 months of age is recommended to maximize the future fertility potential and decrease the TC risk in adulthood.
Collapse
Affiliation(s)
- Giovanni Cobellis
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
- *Correspondence: Giovanni Cobellis, Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Via Corridoni, Ancona 11, Italy e-mail:
| | - Carmine Noviello
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Fabiano Nino
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Mercedes Romano
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Francesca Mariscoli
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Ascanio Martino
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Pio Parmeggiani
- Paediatric Surgery, Department of Paediatrics, Faculty of Medicine, Second University of Naples, Naples, Italy
| | - Alfonso Papparella
- Paediatric Surgery, Department of Paediatrics, Faculty of Medicine, Second University of Naples, Naples, Italy
| |
Collapse
|