Pediatric Minimal Access Surgery Research Articles

Standardized addendums to reporting in neonatal and pediatric minimal access surgery

Minimal access surgeries (MAS) in children and neonates have proven to be safe and effective. Recent advances in technology have significantly contributed to this. However, currently, there is no standardized documentation of minimally access surgery (MAS) in pediatric or neonatal age group. Multiple experimental studies have reported hemodynamic changes taking place in this rather vulnerable cohort many of which are not completely understood. It is important that a standardized reporting tool for accurate documentation of pediatric and neonatal MAS is well overdue. The introduction of such a system will allow for accurate recording of procedures by documenting several variables and facilitate comparisons of various pediatric and MAS procedures between individual centers and institutions.

Documentation in neonatal and pediatric minimal access surgery

Documentation in neonatal and pediatric minimal access surgery

Congenital Diaphragmatic Hernia: Experience and Results of Thoracoscopic Repair from a Tertiary Care Hospital

AbstractIntroduction Congenital diaphragmatic hernia (CDH) is one of the most common congenital anomalies encountered by pediatric surgeons. With the advances in the pediatric minimal access surgery, its role in the repair of CDH has also increased. We have been using thoracoscopy for the repair for CDH since 2015. We herein report our experience of CDH repair in newborns.Materials and Methods A retrospective review was conducted from July 2015 to December 2019 in the Department of Pediatric surgery after ethical approval from the institutional review board and included all the children with CDH who underwent thoracoscopic repair. The case records were used to assess the demographic details, type of defect, and early and late postoperative complications of thoracoscopy in CDH.Results Thoracoscopic repair was attempted in 29 patients of CDH. Eight (27.5%) patients converted to open procedure and were excluded from the study. Primary closure of the diaphragmatic defect was performed in 90.4% (19) patients. Also, 9.5% (2) children required mesh repair. There was no intraoperative death. Postoperative ventilation was required in 57.1% (12) children. The mean time on the ventilator was 3.03 ± 0.9 days. The mean age of children requiring postoperative ventilation was less compared with children who were extubated in the postoperative period (p = 0.032). The median follow-up in our study was 12 months and 28.5% of patients developed recurrence of the diaphragmatic hernia. All the children underwent laparotomy and repair of the diaphragmatic defect.Conclusion Thoracoscopic repair is a safe and effective option for the repair of CDH in children performed by surgeons with significant procedure experience.

Assessment of public access YouTube™ content for pediatric minimal access surgery education

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.

The Impact of Simulator Size on Forces Generated in the Performance of a Defined Intracorporeal Suturing Task: A Pilot Study.

Background: In pediatric minimal access surgery, the operative domain may vary from that of an adult to that of a neonate. This study aimed to quantify the impact of decreased operative domain on forces generated in the performance of a defined intracorporeal suturing task. Methods: One hundred five participants performed a defined intracorporeal suturing task in small and large simulators. Time to task completion and force analysis parameters (FAPs = total, maximum, and mean forces in X, Y, and Z axes) were measured. Expertise level was assigned based on the number of laparoscopic cases. Outcomes were analyzed using paired sample t-tests, P value of <.05. Results: Time to task completion varied significantly for experts between adult and pediatric simulators but not for intermediates or novices. Total, maximum, and mean forces in the X ("side to side") axis were significantly greater in the larger laparoscopic simulator for all levels of expertise. In the Y axis ("in and out" movement) and Z axis ("up and down" movement), total and mean forces were higher in the adult simulator regardless of the level of expertise. Differences in maximum force between the adult and pediatric simulators in the Z axis ("up and down" movement) varied significantly for novices and intermediates but not for experts. Conclusion: Forces were greater, particularly in the side-to-side plane, in the larger simulator for participants of all levels in the performance of this defined intracorporeal suturing task. Further analysis will determine the reasons for and implications of the increased force parameters in the simulator of larger domain.

IPEG 2018The 27th Annual Congress for Endosurgery in ChildrenApril 11–14, 2018, Seattle, Washington

IPEG 2018The 27^th Annual Congress for Endosurgery in ChildrenApril 11–14, 2018, Seattle, Washington

Complications of Minimally Invasive Surgery in Children: A Prospective Morbidity and Mortality Analysis Using the Clavien-Dindo Classification

There is a lack of information about evaluation of pediatric minimal access surgery complications; the Clavien-Dindo classification was never used for a large series of laparoscopic and thoracoscopic pediatric procedures. With a prospective Morbidity and Mortality database, all the minimal access surgical procedures carried out between 2012 and 2016 were included in this study. Statistical analyses were used to valuate modification of surgical techniques in to 2 periods (period 1: January 2012 to February 2014; period 2: February 2014 to February 2016). A total of 1374 minimal access procedures were performed on 1371 patients. The overall complication rate was 2.9%. No differences, in terms of complications, were observed between elective and emergency procedures (P=0.3). There was a significant difference between the complication rate of thoracoscopic surgery (P=0.027). These results provide the relevance of adequate recording system and standardized classification for analyses and reduction of complications for pediatric minimal access procedures.

Motion analysis in the pediatric laparoscopic surgery (PLS) simulator: validation and potential use in teaching and assessing surgical skills

BackgroundConstruct validity for the pediatric laparoscopic surgery (PLS) simulator has been established through a scoring system based on time and precision. We describe the development and initial validation of motion analysis to teach and assess skills related to pediatric minimal access surgery (MAS). MethodsParticipants were asked to perform a standardized intracorporeal suturing task. They were classified as novices, intermediates, and experts. Motion in the four degrees of freedom available during traditional MAS (PITCH, YAW, ROLL and SURGE) was assessed using range, velocity, and acceleration. ResultsAnalysis of motion allowed discrimination between the 75 participants according to level of expertise. The most discriminating motion parameter was the acceleration in performing the ROLL (pronation/supination) with values of 30±27 for novices, 15±5 for intermediates, and 3.7±3 for experts (p<0.001). ConclusionsTracking and analyzing the motion of instruments within the PLS simulator allow discrimination between novices, intermediates, and experts, thus establishing construct validity. Further development may establish motion analysis as a useful “real time” modality to teach and assess MAS skills.

Current status of pediatric minimal access surgery at Sultan Qaboos University Hospital

Objective The objective of this study was to determine the current practices of pediatric minimal access surgery (MAS) in our institute over a period of 3 years. Background data Pediatric MAS has received recognition among pediatric surgeons and is currently being practiced in most centers worldwide. However, studies in our region are limited. Materials and methods This study was carried out in Sultan Qaboos university Hospital (Muscat, Oman). Medical records of all the children (0–12 years) who required abdominal, groin, or thoracic surgery between July 2009 and August 2012 were reviewed. Data analysis was carried out using SPSS v16. Results A total of 904 abdominal, groin, and thoracicprocedures were performed in 790 children. In 257 (28.4%) procedures [emergency = 164 (64%), elective= 93 ( 36%)] minimal access was utilized. In total, 152 (60%) patients were males, whereas 102 (40%) were female. The age of the patients ranged from 0 to 12 years, with an average of 7.02± 3.93 years (SD). Weight ranged from 2.8 to 61 kg [mean =23.74± 12.16 (SD)]. The MAS modality included 251 (97.6%) laparoscopic and six (2.4%) thoracoscopic procedures. Conversion to open and complication rates were 3.5 and 5.05%, respectively. Follow-up period ranged from 3 to 40 months, with an average of 18.05± 8.96 (SD). Conclusion At Sultan Qaboos University Hospital, pediatric MAS is evolving as we are performing a number of diverse procedures at a comparable conversion and complication rate. Keywords : current status, laparoscopy, minimal access surgery, thoracoscopy

The Pediatric Laparoscopic Surgery (PLS) simulator: Methodology and results of further validation

BackgroundThe Pediatric Laparoscopic Surgery (PLS) simulator is the only validated tool for pediatric Minimal Access Surgery. Construct validity (the ability to discriminate between novice, intermediate and expert) for the PLS simulator had previously been established on the basis of the total PLS score, as well as the individual performance on three of the five tasks. We describe the process and methods used to establish independent construct validity for a fourth task: pattern-cutting. MethodsAfter considering various options for the possible modifications of the task itself, we retrospectively altered the way the pattern-cutting task was scored by modifying the weighting of precision versus time without changing the task itself. This was subsequently tested prospectively at the 2011 Canadian Association of Pediatric Surgeons meeting. ResultsModification in the scoring metrics allowed differentiation within a previously tested cohort of 84 candidates (20 novices: score=48±16, 19 intermediates: score=59±18, 45 experts: score=69±12 p=0.01). This was validated prospectively in a cohort of 18 experts and 7 intermediates (65±8, 54±17 p=0.03). ConclusionsConstruct validity for the pattern-cutting task was established by modification of the scoring metrics. This was validated both retrospectively and prospectively.

Skills training in pediatric minimal access surgery

Learning the craft of surgery is central to every surgical program. Although effective, acquisition of skills, particularly that of minimal access surgery in the operating theater, is becoming increasingly difficult. Published data indicate that the early phase of the learning curve could be achieved outside the operating room. However, there is no consensus regarding the optimal training schemes and assessment tools. With an increase in the number of operations performed endoscopically and the number of surgeons performing them, the importance of well-defined and validated training programs cannot be overemphasized.

Teaching impact in pediatric minimal access surgery: Personal perspective from "Fellow"

The global objective of this paper is to review from the “Fellow” perspective, the current status of pediatric minimal access surgery (MAS) in terms of teaching feasibility, safety and impact on standard practice paradigms. In the pediatric general surgery field, surgeons are dealing with a wide range of pathology that includes thoracic, abdominal, urological and gynecological procedures. The learning curve is slow because of a relatively small volume of patients. However, gradually but steadily, a significant proportion of the procedures traditionally performed, with major open exposures at present, are preferentially performed by minimal access. Currently, minimal access surgery training is incorporated into adult general surgery residency/fellowship programs and teaching techniques of pediatric MAS are available only as seldom international workshops. Pediatric surgery fellowship programs with incorporated guidelines for MAS training are just recently feasible in select centers, mostly as “self” established programs. In many other pediatric surgery centers, teaching the “glamour” of MAS is quite dependent on a program director’s vision. Integration of MAS training into the secondary residency/fellowship curriculum of pediatric surgeons is the inevitable goal. MAS- minded education and research through adequate training will pay dividends and “manufacture” competent, contemporary trainees. National Pediatric Surgery Associations should be responsible for setting criteria that consider the MAS for accreditation with maintaining the international standards of these teaching programs.

Pediatric Minimal Access Surgery,

Kim, Jeffrey J. MD; Dreyer, W Jeffrey MD; Chang, Anthony C. MD; Breinholt, John P. III MD; Grifka, Ronald G. MD Author Information