Journal of Pediatric Surgery Open最新文献

{"title":"Applications of Indocyanine Green (ICG) fluorescence in pediatric colorectal conditions","authors":"Ismael Elhalaby ,&nbsp;Elizaveta Bokova ,&nbsp;Seth Saylors ,&nbsp;Irene Isabel P. Lim ,&nbsp;Rebecca M. Rentea","doi":"10.1016/j.yjpso.2024.100165","DOIUrl":"10.1016/j.yjpso.2024.100165","url":null,"abstract":"<div><p>Postoperative success in pediatric colorectal surgery hinges on achieving adequate perfusion during complex reconstructive procedures. This review synthesizes findings from recent publications regarding the application of Indocyanine Green (ICG) in various surgical interventions for conditions such as Hirschsprung disease, anorectal malformations, cloacal reconstructions, and others.</p><p>Preliminary evidence suggests that ICG fluorescence enhances intraoperative decision-making by improving vascular visualization and assessing tissue perfusion. Compared to conventional methods, ICG may offer superior evaluation of intestinal perfusion.</p><p>While initial reports indicate a favorable safety profile for ICG use in pediatric patients, further prospective studies are needed to confirm these observations, quantify benefits, and assess its impact on surgical outcomes. By providing real-time perfusion data, ICG holds promise for enhancing surgical precision and improving patient outcomes in pediatric colorectal surgery.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000509/pdfft?md5=670c14d5c570d20c446f79748f4dc6cc&pid=1-s2.0-S2949711624000509-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway exploration when suspected foreign body aspiration. Is it always indicated?","authors":"Maria Martinez Diaz,&nbsp;Vicente Ibañez Pradas,&nbsp;Miguel Couselo Jerez,&nbsp;Estíbaliz Valdés Diéguez","doi":"10.1016/j.yjpso.2024.100163","DOIUrl":"10.1016/j.yjpso.2024.100163","url":null,"abstract":"<div><h3>Background</h3><p>Foreign body aspiration (FBA) is an important cause of morbidity and mortality in pediatrics. Flexible or rigid bronchoscopy is the gold standard for its diagnosis and treatment. However, despite being a minimally invasive test, it is not without risk and, given the low specificity of symptoms involved, between 45 and 70 % of diagnostic bronchoscopies (DB) performed are normal. The aim of this paper is to develop a strategy in order to reduce this percentage.</p></div><div><h3>Methods</h3><p>Observational, analytical, and retrospective study of DB performed for suspected FBA between 2018 and 2022. Demographic, clinical, and radiological data, bronchoscopy findings and complications were obtained.</p></div><div><h3>Results</h3><p>96 patients admitted to DB were analyzed. 72 out of 96 (75 %) were normal. The risk of presenting a foreign body was significantly higher in patients with suspected nuts, so DB should be always indicated. In patients with suspected other materials aspiration, a multivariate analysis was performed using logistic regression. Statistically significant association was found between dyspnea, asymmetric auscultation and abnormal chest radiography with the presence of a foreign body on the DB; AUC = 0.97 (95 % CI 92.4 %-100 %). The proposed algorithm establishes patients at high risk of FBA and therefore the DB is recommended, with a sensitivity of 100 % and a specificity of 87.2 %.</p></div><div><h3>Conclusions</h3><p>The application of the algorithm to patients with suspected aspiration of a foreign body other than nuts can facilitate the identification of patients with high risk of aspiration and reduce the percentage of negative DB.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000480/pdfft?md5=e7d34cece036084576aa31733293e5b7&pid=1-s2.0-S2949711624000480-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical evaluation and fecal continence of laparoscopic-assisted procedures for total colonic aganglionosis","authors":"Chaosheng He ,&nbsp;Suolin Li","doi":"10.1016/j.yjpso.2024.100160","DOIUrl":"10.1016/j.yjpso.2024.100160","url":null,"abstract":"<div><p>Total colonic aganglionosis (TCA), defined as aganglionosis extending from the anus up to the distal ileum, is a rare variant of Hirschsprung's disease. Surgery for TCA aims to remove the aganglionic colon and reconstruct the intestinal tract by bringing the normally innervated ileum down to the anus while preserving normal sphincter function. Laparoscopy with surgeries including laparoscopic-assisted Duhamel-like and Soave-like pull-through procedures have been progressively applied to the treatment of TCA over the past two decades and may become the dominant treatment for TCA in the future. Postoperative fecal continence, involving issues such as normal defecation, Hirschsprung-associated enterocolitis (HAEC), frequent stool and perianal erosion (perineal rash), soiling/fecal incontinence and constipation/obstructive symptoms, is very important to patients. These complications require nutritional support and comprehensive postoperative gastroenterological care and even require permanent ileostomy and redo pull-through. Some patients have previously seen a psychologist for frequent complaints of diarrhea and other physical symptoms. Patients with TCA postoperatively must be evaluated regularly by pediatric surgeons, enterostoma therapists, gastroenterologists, dieticians and psychologists to achieve a good nutritional status and psychological health.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000455/pdfft?md5=c54cdbcd99cd55eb2821c766db896617&pid=1-s2.0-S2949711624000455-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective comparison of minimally invasive glaucoma surgery techniques for goniotomy in primary congenital glaucoma: Optimizing intraocular pressure control","authors":"Mayor Orezime Atima ,&nbsp;Ugbede Idakwo ,&nbsp;Ayodele Jacob Orugun ,&nbsp;Oyeronke Komolafe ,&nbsp;Melchizedek Ignatius Munaje ,&nbsp;Eisuke Shimizu ,&nbsp;Nakayama Shintaro ,&nbsp;Emmanuel Oluwadare Balogun ,&nbsp;Emeka John Dingwoke","doi":"10.1016/j.yjpso.2024.100162","DOIUrl":"10.1016/j.yjpso.2024.100162","url":null,"abstract":"<div><h3>Background</h3><p>A family of less invasive glaucoma procedures has been developed to provide moderate reductions in intraocular pressure and medication burden in eyes with therapeutic needs that may not warrant the risks associated with trabeculectomy and tube shunt implantation. This study aims to compare the effectiveness and clinical outcomes of pediatric goniotomy using minimally invasive glaucoma surgery techniques to manage primary congenital glaucoma.</p></div><div><h3>Materials and methods</h3><p>Using a computer-generated set of random numbers, the patients were randomized into three groups: Kahook blade group, microvitreoretinal blade group, and 23G needle group. Each group contained 22 eyes. All patients underwent anesthesia for intraocular pressure measurement, corneal diameter evaluation, and fundoscopy. Preoperative intraocular pressure at presentation and postoperative intraocular pressure were recorded during a one-year follow-up period. Outcome measures included decreases in corneal diameter from preoperative size, mean postoperative reduction in intraocular pressure for each minimally invasive glaucoma surgery technique and absence of intraoperative or postoperative complications. Surgical success was defined as a postoperative intraocular pressure of ≤20 mmHg without antiglaucoma medications or reoperation, based on the last recorded intraocular pressure during postoperative follow-up.</p></div><div><h3>Results</h3><p>A total of 66 eyes were diagnosed with primary congenital glaucoma and underwent goniotomy surgeries during the study period in 2022. The majority (89%) were bilateral cases. Among the patients, there were 26 males and 9 females, which makes up an 8: 2 male-to-female ratio, with an average age range of 2 months to 2 years. After a one-year postoperative follow-up, a significant reduction in intraocular pressure was achieved of ≤18 mmHg. In terms of surgical success with minimally invasive glaucoma surgery techniques, goniotomy with a 23-gauge needle had the most postoperative intraocular pressure, followed by the microvitreoretinal blade and the Kahook blade. On average, the 23-gauge needle had a corneal diameter of 13.8 mm, while the microvitreoretinal blade was 13.9 mm and the Kahook blade recorded 14 mm.</p></div><div><h3>Conclusions</h3><p>Goniotomy using minimally invasive glaucoma surgery techniques has been proven to be an effective surgical technique for the management of childhood glaucoma among Nigerian patients. A reduction in postoperative intraocular pressure, corneal diameter, and absence of complications provide clinical evidence of successful glaucoma management and preservation of outcomes of visual function in patients.</p></div><div><h3>Level of evidence</h3><p>Level 1 (Prospective study)</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000479/pdfft?md5=ae7958077c9c2eb16403b1d9b0b2a15f&pid=1-s2.0-S2949711624000479-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of social vulnerability and rehospitalization in pediatric motor vehicle trauma patients","authors":"Meagan Rosenberg ,&nbsp;Alexander Knee ,&nbsp;Aixa Perez Coulte ,&nbsp;Michael V. Tirabassi","doi":"10.1016/j.yjpso.2024.100161","DOIUrl":"10.1016/j.yjpso.2024.100161","url":null,"abstract":"<div><h3>Introduction</h3><p>We investigated social vulnerability index (SVI) as a tool to identify children at risk for readmission following motor vehicle collisions (MVC).</p></div><div><h3>Materials and Methods</h3><p>An exploratory retrospective cohort study was conducted of pediatric trauma activations (age 0–15) for MVCs 1/1/2012 to 6/30/2022 at a level 1 trauma center. Eligibility included residence within our center's catchment area. Excluded were mortalities during the index admission. Patient address was geocoded and linked with state-level census tract SVI. Per the CDC, SVI ≥90th percentile defined high vulnerability. We evaluated SVI theme: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), housing and transportation (HT). Outcomes included emergency department (ED) visits and re-hospitalization within 90 days of discharge. Kaplan-Meier plots, relative risk (aRR), and 95 % confidence intervals (95 %CI) adjusted for injury severity score (ISS) were estimated using log-binomial regression.</p></div><div><h3>Results</h3><p>Of 429 eligible subjects, 122 (28 %) resided in high SVI communities. High SVI patients had slightly higher mean ISS (8.6 vs 7.5). There was a similar risk of ED re-presentation across SVI groups (aRR=1.18; 95 %CI 0.61–2.29). However, although estimates were unstable, there was a possibility of increased risk of re-hospitalization among the high SVI group (aRR=2.34; 95 %CI 0.68–8.04). By theme, HT had the strongest association (aRR=1.71) for ED representation, whereas SES and HCD had the strongest associations for rehospitalization (aRR=2.03, 2.66, respectively).</p></div><div><h3>Conclusion</h3><p>We observed possible associations between high SVI and higher rates of re-hospitalization. Future research with a larger sample may clarify associations.</p></div><div><h3>Level of Evidence</h3><p>Level IV; Prognosis Study.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000467/pdfft?md5=6b69c0987cfa5a18a3f8c0cc58296bd2&pid=1-s2.0-S2949711624000467-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of biobehavioral interventions in children undergoing surgery and associated patient-reported outcomes","authors":"Gwyneth A. Sullivan ,&nbsp;Yao Tian ,&nbsp;Willemijn L.A. Schäfer ,&nbsp;Kayla M. Giger ,&nbsp;Maxwell Joseph Willberding ,&nbsp;Audra J. Reiter ,&nbsp;Bonnie Essner ,&nbsp;Andrew J. Hu ,&nbsp;Martha C. Ingram ,&nbsp;Salva Balbale ,&nbsp;Julie K. Johnson ,&nbsp;Jane L. Holl ,&nbsp;Mehul V. Raval","doi":"10.1016/j.yjpso.2024.100159","DOIUrl":"10.1016/j.yjpso.2024.100159","url":null,"abstract":"<div><h3>Background</h3><p>: Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes.</p></div><div><h3>Methods</h3><p><em>:</em> We conducted an embedded mixed-methods study with a quantitative focus. Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial for children, ages 10–18 years, undergoing elective gastrointestinal surgery. Patients/caregivers were surveyed about preoperative exposure to and postoperative use of biobehavioral interventions. Four semi-structured group interviews with 20 pediatric surgery providers were conducted. Outcomes included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness.</p></div><div><h3>Results</h3><p><em>:</em> 41 % (<em>n</em> = 67) of 164 enrolled patients/caregivers reported preoperative exposure to and 71 % (<em>n</em> = 117) reported postoperative use of a biobehavioral intervention(s). Barriers to incorporation of biobehavioral interventions included lack of standardized workflows, clinician knowledge, and resources. Potential facilitators included media and peer-counseling. After adjusting for individual and hospital characteristics, those who reported using a biobehavioral intervention(s) were 70 % less likely to report worsened postoperative nervousness (95 % CI 0.10–0.91; <em>p</em> = 0.03). Reported use of a biobehavioral intervention(s) was not found to be associated with pain-related functional disability or HRQoL.</p></div><div><h3>Conclusions</h3><p><em>:</em> Use of a biobehavioral intervention(s) may stabilize postoperative nervousness of children undergoing surgery. There is a need for redesign of clinical workflows and clinician training to facilitate integration of biobehavioral interventions.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000443/pdfft?md5=a3f602fe152265a0786fd9d56fcd2472&pid=1-s2.0-S2949711624000443-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segmental intestinal reconfiguration (SIR) in combined reconstructions for ultrashort bowel syndrome","authors":"Vasily V. Nikolaev ,&nbsp;Julia Averyanova","doi":"10.1016/j.yjpso.2024.100158","DOIUrl":"10.1016/j.yjpso.2024.100158","url":null,"abstract":"<div><h3>Background</h3><p>Ultrashort bowel syndrome represents the most rare and complex variant of the short bowel syndrome. Autologous intestinal reconstructions for ultrashort bowel syndrome is typically reserved for severe cases characterized by symptomatic dysmotility within the ultrashort dilated segments. Limited surgical techniques are available to substantially increase the length of ultrashort bowels with asymmetric and highly dilated segments.</p><p>We present a case series detailing the application of a technique for lengthening and tapering significantly dilated ultrashort bowels – segmental intestinal reconfiguration (SIR), based on the Yang-Monti principle. Our analysis delves into the technical features across various anatomical variants and provides mid-term results.</p></div><div><h3>Methods</h3><p>From 2021 to 2022, patients experiencing dysmotility in dilated ultrashort bowel segments with a preserved colon underwent sequential combined intestinal reconstructions. Assessments were conducted 18–24 months post-surgery, and statistical calculations employed nonparametric methods to compare pre- and postoperative results.</p></div><div><h3>Results</h3><p>Six patients, with a median age of 48.5 months, underwent autologous intestinal reconstructions, including SIR. The serial transverse enteroplasty (STEP) was performed on the dilated duodenum in five children, and colon interposition in two. The length of the small bowel exhibited a significant difference before and after surgery (<em>p</em> = 0.031). No complications were observed in the postoperative period. The postoperative group demonstrated a lower dependence on parenteral nutrition (NPEI/REE &lt; 80 % in 6 (100.0 %); <em>p</em> = 0.007). Enteral autonomy was restored in two children.</p></div><div><h3>Conclusions</h3><p>The results of SIR technique in combined reconstructions for ultrashort bowel syndrome in a carefully selected cohort of children demonstrate feasibility and reliability, as well as the restoration of intestinal transport function at midterm evaluation. This comprehensive approach resulted in increased enteral tolerance and reduced parenteral requirements.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000431/pdfft?md5=5c4615bdc1f13994ab332d608b77ec64&pid=1-s2.0-S2949711624000431-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted thoracoscopic versus conventional thoracoscopic plication for diaphragmatic eventration in children: Comparison of mid-term outcomes","authors":"Mengxin Zhang ,&nbsp;Jingfeng Tang ,&nbsp;Yuan Liu ,&nbsp;Zhiqing Cao ,&nbsp;Kangtai Wang ,&nbsp;Guoqing Cao ,&nbsp;Xi Zhang ,&nbsp;Shao-tao Tang","doi":"10.1016/j.yjpso.2024.100157","DOIUrl":"10.1016/j.yjpso.2024.100157","url":null,"abstract":"<div><h3>Objective</h3><p>Minimally invasive surgery has been widely used for diaphragmatic eventration (DE). We aimed to compare the mid-term outcomes of robot-assisted thoracoscopic (RTP) and conventional thoracoscopic plication (CTP) for DE and to discuss the technical advantages of RTP.</p></div><div><h3>Methods</h3><p>From January 2015 to July 2022, the clinical outcomes of 30 RTP patients and 35 CTP patients were retrospectively analyzed. The baseline data, surgical outcomes and surgical technique will be compared in detail.</p></div><div><h3>Results</h3><p>The baseline data of two groups were comparable. No intraoperative conversion or complications occurred. The total operation time and intraoperative blood loss were similar between two groups, but RTP group had a significantly shorter diaphragmatic plication time compared to CTP group (25.77±3.55 min vs 44.49±4.43 min, <em>p</em> &lt; 0.001). The total surgical cost of RTP group was higher than that of CTP group (48,593.06±2752.33 RMB vs 25,181.23±5681.51 RMB, <em>p</em> &lt; 0.001). No significant differences were found in postoperative hospital stay, diclofenac suppository dosage, unplanned readmission rate within 30 days postoperatively, recurrence rate, or postoperative complications within 1 year postoperatively between RTP and CTP groups. Sixty patients had preoperative symptoms resolved or significantly improved with normal diaphragmatic position. However, two patients in CTP group encountered recurrence, and one patient in CTP group and two patients in RTP group had a diaphragm descent in only one intercostal space.</p></div><div><h3>Conclusion</h3><p>RTP is a feasible and effective minimally invasive option for the treatment of DE, with mid-term outcomes comparable to CTP, which has a great advantage in terms of easier suturing and free knotting. DE can serve as an ideal disease type to train robots for thoracoscopic surgery by young doctors.</p></div><div><h3>Level of evidence</h3><p>Level III.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294971162400042X/pdfft?md5=dd9053abb546cc2e32d9b859710cde44&pid=1-s2.0-S294971162400042X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141630718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedi-Bots: Innovations and progress in robotic pediatric general surgery","authors":"Krysta M Sutyak ,&nbsp;KuoJen Tsao","doi":"10.1016/j.yjpso.2024.100156","DOIUrl":"10.1016/j.yjpso.2024.100156","url":null,"abstract":"<div><p>Robotic Assisted Surgical Systems for abdominal surgery began human trials in adults in the 1990s [<span>1</span>,<span>2</span>]. The first commercially available system was approved for use in Europe and the United States by 2000 [<span>2</span>,<span>3</span>]. Almost 25 years later, robotic surgery is commonplace in most areas of general surgery in adults and is utilized nationally and internationally throughout most other surgical specialties. The first robotic pediatric surgery, a Nissan fundoplication, was completed in 2000 [<span>4</span>]. In relatively similar time periods where robotic surgery has become widespread in the adult population, its use has remained limited in pediatric patients. This is most often attributed to limitations secondary to the patient's size relative to the size of the robot and instruments[<span>5</span>,<span>6</span>]. In this article, we aim to review the robotic technology currently available in pediatrics, the advantages of robotic surgery, the use and safety of robotics in pediatric general surgery, and the challenges or limitations of its use, highlighting how surgeons and centers are utilizing this technology and implementing robotic practices despite these obstacles.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100156"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000418/pdfft?md5=b5e2b12710654b14d599da7858503d4d&pid=1-s2.0-S2949711624000418-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department Thoracotomy: A National Trauma Databank analysis","authors":"Taylor Glassman ,&nbsp;Sathyaprasad Burjonrappa","doi":"10.1016/j.yjpso.2024.100154","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100154","url":null,"abstract":"<div><h3>Introduction</h3><p>Emergency Department Thoracotomy (EDT) warrants further investigation in the pediatric population due to concerns about its futility. Our study evaluates how patient demographics, injury characteristics, and physiologic status influence pediatric EDT outcomes in blunt and penetrating trauma.</p></div><div><h3>Methods</h3><p>This retrospective study analyzed patients ≤19 years who received EDT within 1 hour of arrival to the ED from the National Trauma Data Bank. Cases were stratified by blunt and penetrating trauma. Descriptive statistics and univariate analysis were used to identify predictors of survival post-EDT.</p></div><div><h3>Results</h3><p>Of the 1,075 pediatric patients who underwent Emergency Department Thoracotomy (EDT), 79.6 % experienced penetrating trauma and 20.4 % blunt trauma, with survival rates at 25.9 % and 9.1 %, respectively. Survivors of penetrating trauma typically presented with more stable vital signs, such as pulse rate, oximetry, and Glasgow Coma Scale (GCS) scores, and lower Injury Severity Scores (ISS), all correlating with survival (p &lt; 0.05). Survivors of blunt trauma were distinguished by higher respiratory rates and temperatures (p &lt; 0.05). Risk factor analysis indicated that age-adjusted bradycardia, age-adjusted hypotension, and pre-hospital cardiac arrest were significant predictors of mortality across trauma types (penetrating trauma: OR = 18.7, 6.2, and 20.7; blunt trauma: OR = 12, 2.69, and 6.4, all p &lt; 0.05). Notably, pre-hospital respiratory support was associated with a reduced risk of mortality for both types of trauma (OR = 0.32 for penetrating, and OR = 0.23 for blunt, p &lt; 0.05).</p></div><div><h3>Conclusions</h3><p>The study affirms the significance of pre-hospital care, showing that stable vitals and respiratory support enhance pediatric thoracotomy outcomes. Ongoing research into pediatric-specific trauma protocols are needed.</p></div><div><h3>Type of Study</h3><p>Retrospective cohort</p></div><div><h3>Level of Evidence</h3><p>III</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100154"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294971162400039X/pdfft?md5=e6da275be2ccb8802f406569f3485361&pid=1-s2.0-S294971162400039X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}