Pediatric Endoscopic Surgery

Paediatric robotic surgery and urology: where are we?

Laparoscopic approach to an echinococcal liver cyst in a boy with giant 3 organ cystic manifestation

Posterior One-Trocar-Assisted Pyeloplasty Abstract Introduction Ureteropelvic junction obstruction is the most common pediatric obstructive uropathy. Retroperitoneal laparoscopic-assisted dismembered pyeloplasty (OTAP) combines the advantages of a retroperitoneal approach with the high success rate of the open technique. A modification of the OTAP, using a posterior muscle-sparing incision to approach the kidney, is described. Surgical technique With the patient placed in prone position, a transverse 15-mm-long skin incision is made. A 12-mm balloon Hasson trocar with operative telescope is inserted after the Gerota's fascia has been opened. The ureteropelvic junction is exteriorized and a traditional dismembered pyeloplasty is performed. Discussion The posterior approach allows a quick and easy access to the renal lodge and does not require the incision of abdominal wall muscles and the parietal peritoneum does not interfere with the procedure. Furthermore, the exteriorization of the ureteropelvic junction is easy, because the space between its natural position and the skin is short, consisting only in subcutaneous tissue. Conclusion The posterior modified approach to the kidney for OTAP procedure is a good option, as an alternative to lumbotomic lateral access, allowing a good visualization of the kidney lodge, together with easy and rapid exteriorization of the ureteropelvic junction.

Short-interval staged thoracoscopic surgery for long-gap esophageal atresia Abstract Purpose Long-gap esophageal atresia is defined by the impossibility to perform a primary anastomosis after birth. We propose a progressive traction surgery by thoracoscopy performed at intervals of 5–7 days. Methods We describe the traction technique of the esophageal pouches through the thoracoscopic approach and without performing a gastrostomy. We use sliding sutures and clips to prevent esophageal tearing and preservation of the azygos vein. Results In a series of three patients, we have being able to reconstruct the esophagus in a period of 1–3 weeks after birth without complications. Conclusions Repetitive thoracoscopy at shorts intervals in the neonatal period allows a tension-free anastomosis of the esophagus in long-gap type esophageal atresia.

Perspectives on pediatric endoscopic surgery

30 Years of pediatric endoscopic surgery and the challenge goes on

Assessment of public access YouTube™ content for pediatric minimal access surgery education Abstract YouTube™ is a video-sharing open-access online platform with more than 1 billion users. The number of users and uploaded videos with medical content is increasing every day. Though e-learning has advantages and use of social media has found place in modern education, this short communication is about YouTube™, that is one of leading social media, having an impact on pediatric surgery trainees in minimal access surgery.

Laparoscopic options in superior mesenteric artery syndrome in children: systematic review Abstract Purpose Superior mesenteric artery syndrome (SMAS) refers to the compression of the third portion of the duodenum between the aorta and the superior mesenteric artery, and usually results from weight loss or alteration in spine anatomy. This study reviewed laparoscopic options regarding SMA S in children. Methods MEDLINE/PubMed was reviewed. Studies in patients under 16 years of age and published in English/Spanish were included, and selected by two independent reviewers. Data were collected for age, gender, weight/body mass index, comorbidities, symptoms, surgical technique, complications, conversions, recurrence and mortality. Descriptive statistics were used to analyze the quantitative portion of the study, with results presented as percentages, means and medians. Results Twelve papers with n = 16 patients were included. Mean/median age were 10.7 and 13 years, respectively, with female predominance (n = 11, 68.75%). Emesis (n = 15, 93.75%) and abdominal pain (n = 11, 68.75%) were the most common symptoms. Anorexia nervosa was present in n = 1, and n = 1 patient had recent history of spinal fusion for idiopathic scoliosis. Regarding surgical technique, eleven cases consisted of duodenojejunostomy with side-to-side anastomosis (one associated with feeding jejunostomy); two Strong's procedures; and three Ladd's procedures. There were no conversions, and n = 2 (12.5%) minor complications (self-limited upper gastrointestinal bleed and persistence of vomiting for 48 h post-operatory). There was no mortality. Mean and median follow-up were 44.5 and 48 weeks, respectively, with no recurrences. Conclusions SMAS is uncommon in children. The preferred laparoscopic approach is duodenojejunostomy, which can provide definitive relief of the obstruction with minor complications and low recurrence.

Laparoscopy in infants: close intraoperative hemodynamic monitoring for patient safety Abstract Background Hemodynamic changes during laparoscopy have not been well defined in very young children. In this study, intraoperative monitoring of hemodynamic parameters and oxygenation was evaluated during laparoscopy in infants weighing < 10 kg. Patients and methods Thirty infants (5.07 ± 2.51 kg), undergoing laparoscopy (LAP Group, n = 15) or open surgery (Open Group, n = 15), were enrolled. Cerebral regional (crScO2), renal regional oxygenation (rrScO2), peripheral oxygen saturation (SpO2), heart rate (HR), blood pressure, transcutaneous CO2 (TcCO2), end-tidal CO2 (EtCO2), and core temperature (TC) were analyzed at five intervals: T0 = basal; T1 = anesthesia induction; T2 = CO2 PP insufflation in the LAP group; T3 = intraoperative; T4 = cessation of CO2 PP in the LAP group; and T5 = before extubation. Results The LAP group showed differences in crScO2 at T1, T3, and T4 compared with T0 (p < 0.05) and in rrScO2 from T1 to T4 versus T0 (p < 0.05), without hypoxemia. In addition, in the LAP group, an increase in TcCO2 from T2 to T5 versus T0 (p < 0.01) was related to anesthesia time (p = 0.01) and sex (p = 0.03). The SpO2 values were not different during laparoscopy; on the contrary, the OPEN group exhibited a decrease in SpO2 at T4 (p < 0.001) and an increase at T5 versus T0 (p = 0.001) compared with T0. HR and TC changes were detected in both groups (p < 0.01). No significant variations were recorded in blood pressure or end-tidal CO2. Conclusion Limited effects on oxygenation, cardiac output, and thermoregulation were detected in infants during laparoscopy. Many factors, including the child's age, may play different roles in the regulation of these parameters. Close monitoring is essential to guarantee the infant's safety.

How to differentiate congenital pancreatic cysts and cystic pancreatic teratomas? Abstract Purpose The differential diagnosis of congenital pancreatic cysts and mature cystic pancreatic teratomas is challenging due to the lack of reliable diagnostic tests or pathognomonic imaging findings. This study highlights the differences between these extremely rare entities with few published case reports. Methods Based on our recent experience with two cases, we conducted an extensive review of literature including all reported cases of congenital pancreatic cysts and cystic pancreatic teratomas in children. Results We report two cases of large cystic abdominal mass detected by prenatal ultrasonography. Both neonates were asymptomatic after birth and were operated on by laparoscopy at the age of 1 year and 3 months, respectively. Histopathology demonstrated a congenital pancreatic cyst in the first case and a mature cystic teratoma in the second case. The post-operative course was uneventful for both children. We describe the clinical and imaging data of the 33 congenital pancreatic cysts and 10 mature cystic teratomas of the pancreas previously reported in the literature, and discuss diagnosis criteria and treatment strategies. Conclusion Congenital pancreatic cysts and pancreatic teratomas are rare lesions in children. Clinical presentation is not specific and these lesions are often asymptomatic. Although associated malformations are evocative of congenital pancreatic cyst, the final diagnosis can only be confirmed by histopathological examination. Available treatments include ultrasound-guided puncture, enucleation, distal pancreatectomy, cystogastrostomy, and cysto-jejunostomy by the Roux-en-Y technique. Laparoscopic excision can be performed shortly after birth and is our preferred option.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com