Seminars in Pediatric Surgery最新文献

{"title":"Diaphragmatic pacing for respiratory failure in children","authors":"Daniel J. Robertson ,&nbsp;Paul M. Jeziorczak ,&nbsp;Charles J. Aprahamian","doi":"10.1016/j.sempedsurg.2024.151386","DOIUrl":"10.1016/j.sempedsurg.2024.151386","url":null,"abstract":"<div><p>Diaphragm pacing is a ventilation strategy in respiratory failure. Most of the literature on pacing involves adults with common indications being spinal cord injury and amyotrophic lateral sclerosis (ALS). Previous reports in pediatric patients consist of case reports or small series; most describe direct phrenic nerve stimulation for central hypoventilation syndrome. This differs from adult reports that focus most commonly on spinal cord injuries and the rehabilitative nature of diaphragm pacing. This review describes the current state of diaphragm pacing in pediatric patients. Indications, current available technologies, surgical techniques, advantages, and pitfalls/problems are discussed.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 1","pages":"Article 151386"},"PeriodicalIF":1.7,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1055858624000076/pdfft?md5=6e3fb765b7cba39de0214b4e6d18ca5a&pid=1-s2.0-S1055858624000076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139422492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-surgical approaches to the management of chest wall deformities","authors":"Jacky Z Kwong,&nbsp;Brian CH Gulack","doi":"10.1016/j.sempedsurg.2024.151388","DOIUrl":"10.1016/j.sempedsurg.2024.151388","url":null,"abstract":"<div><p><span>Chest wall deformities in children encompass a broad spectrum of disorders but </span>pectus excavatum<span> and carinatum are by far the most common. Treatment varies substantially by center, and depends on patient symptoms, severity of disease, and surgeon preference.</span></p><p><span>Historically, surgical approaches were the mainstay of treatment for these disease processes but new advances in non-surgical approaches have demonstrated reasonable results in select patients. These non-surgical approaches include vacuum bell therapy, autologous fat grafting and hyaluronic acid injections for pectus excavatum, and </span>orthotic<span> brace therapy for pectus carinatum. There is debate with regards to optimal patient selection for these non-surgical approaches, as well as other barriers including reimbursement issues.</span></p><p>This paper will review the current non-surgical approaches to chest wall deformities available, including optimal patient selection, treatment protocols, indications, contraindications, and outcomes.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 1","pages":"Article 151388"},"PeriodicalIF":1.7,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139421009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in pediatric surgery","authors":"Anthony Y. Tsai ,&nbsp;Stewart R. Carter ,&nbsp;Alicia C. Greene","doi":"10.1016/j.sempedsurg.2024.151390","DOIUrl":"10.1016/j.sempedsurg.2024.151390","url":null,"abstract":"<div><p>Artificial intelligence (AI) is rapidly changing the landscape of medicine and is already being utilized in conjunction with medical diagnostics and imaging analysis. We hereby explore AI applications in surgery and examine its relevance to pediatric surgery, covering its evolution, current state, and promising future. The various fields of AI are explored including machine learning and applications to predictive analytics and decision support in surgery, computer vision and image analysis in preoperative planning, image segmentation, surgical navigation, and finally, natural language processing assist in expediting clinical documentation, identification of clinical indications, quality improvement, outcome research, and other types of automated data extraction. The purpose of this review is to familiarize the pediatric surgical community with the rise of AI and highlight the ongoing advancements and challenges in its adoption, including data privacy, regulatory considerations, and the imperative for interdisciplinary collaboration. We hope this review serves as a comprehensive guide to AI's transformative influence on surgery, demonstrating its potential to enhance pediatric surgical patient outcomes, improve precision, and usher in a new era of surgical excellence.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 1","pages":"Article 151390"},"PeriodicalIF":1.7,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139376118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Framework for pediatric robotic surgery program development","authors":"Chirag Ram ,&nbsp;J. Benjamin Pitt ,&nbsp;Marshall W. Wallace ,&nbsp;Seth D. Goldstein ,&nbsp;Irving J. Zamora","doi":"10.1016/j.sempedsurg.2024.151389","DOIUrl":"10.1016/j.sempedsurg.2024.151389","url":null,"abstract":"<div><p>Pediatric robotic surgery has seen increasing implementation for its many benefits over the past two decades. As more pediatric surgeons gain exposure to robotic surgery, the interest in utilizing this technology is growing. However, there are no guidelines or existing framework for developing pediatric general surgery robotic programs. Programmatic development can be challenging, requiring institutional support, a minimum 12-month multistep process in partnership with the robot manufacturer, and organization of a local dedicated team. A cornerstone to all program building is collaboration and communication with key stakeholders who are committed to establishing a robotic surgery program. In this manuscript, we detail numerous best practices for implementation, followed by three variations of programmatic development, each drawing lessons from one of three practice settings: (i) A children's hospital in a large medical center associated with an adult hospital, (ii) a free-standing children's hospital, and (iii) a community-based practice. We aim for this article to provide a framework that can serve as a guide for those beginning this process, consolidating the key resources and strategies used to develop a robust pediatric robotic surgery program.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 1","pages":"Article 151389"},"PeriodicalIF":1.7,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1055858624000106/pdfft?md5=cfff18a5362d5687b1f399f282fd3c85&pid=1-s2.0-S1055858624000106-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139375944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine green (ICG) fluorescence-enhanced applications in pediatric surgery","authors":"John Sincavage ,&nbsp;Brian C. Gulack ,&nbsp;Irving J. Zamora","doi":"10.1016/j.sempedsurg.2024.151384","DOIUrl":"10.1016/j.sempedsurg.2024.151384","url":null,"abstract":"<div><p>The breadth of pediatric surgical practice and variety of anatomic anomalies that characterize surgical disease in children and neonates require a unique level of operative mastery and versatility. Intraoperative navigation of small, complex, and often abnormal anatomy presents a particular challenge for pediatric surgeons. Clinical experience with fluorescent tissue dye, specifically indocyanine green (ICG), is quickly gaining widespread incorporation into adult surgical practice as a safe, non-toxic means of accurately visualizing tissue perfusion, lymphatic flow, and biliary anatomy to enhance operative speed, safety, and patient outcomes. Experience in pediatric surgery, however, remains limited. ICG-fluorescence guided surgery is poised to address the challenges of pediatric and neonatal operations for a growing breadth of surgical pathology. Fluorescent angiography has permitted intraoperative visualization of colorectal flap perfusion for complex pelvic reconstruction and anastomotic perfusion after esophageal atresia repair, while its hepatic absorption and biliary excretion has made it an excellent agent for delineating the dissection plane in the Kasai portoenterostomy and identifying both primary and metastatic hepatoblastoma lesions. Subcutaneous and intra-lymphatic ICG injection can identify iatrogenic chylous leaks and improved yields in sentinel lymph node biopsies. ICG-guided surgery holds promise for more widespread use in pediatric surgical conditions, and continued evaluation of efficacy will be necessary to better inform clinical practice and identify where to focus and develop this technical resource.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 1","pages":"Article 151384"},"PeriodicalIF":1.7,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1055858624000052/pdfft?md5=b403a42cee357aba51811b884611f973&pid=1-s2.0-S1055858624000052-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139376208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intercostal spinal nerve cryoablation for analgesia following pectus excavatum repair","authors":"Mallory N. Perez ,&nbsp;Anthony Ferrantella ,&nbsp;Kevin N. Johnson ,&nbsp;Seth D. Goldstein","doi":"10.1016/j.sempedsurg.2024.151382","DOIUrl":"https://doi.org/10.1016/j.sempedsurg.2024.151382","url":null,"abstract":"<div><p>Pectus excavatum<span><span><span> is a common chest wall deformity, most often treated during adolescence, that presents a significant </span>postoperative pain<span> control challenge for pediatric surgeons following surgical correction. The purpose of this article is to review the technique and outcomes of intercostal spinal nerve cryoablation for </span></span>postoperative analgesia<span> following surgical correction of pectus excavatum. Contemporary and historic literature were reviewed. Findings are summarized to provide a concise synopsis of the benefits of intercostal spinal nerve cryoablation relative to alternative analgesic modalities, as well as advocate for more widespread inclusion of this technique into multimodal pain regimens.</span></span></p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 1","pages":"Article 151382"},"PeriodicalIF":1.7,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139111551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applications for ultrasound in pediatric surgery","authors":"Kevin N. Johnson ,&nbsp;Jonathan Vacek ,&nbsp;Stewart Carter","doi":"10.1016/j.sempedsurg.2024.151383","DOIUrl":"https://doi.org/10.1016/j.sempedsurg.2024.151383","url":null,"abstract":"<div><p>Ultrasound (US) use within pediatric surgery is expanding rapidly. While US guidance for central line placement has been common practice for many years now, advances in the quality of images, portability of US machines, and a lack of radiation associated with imaging has led to broader application in many other aspects of surgery, ranging from diagnostics to performing operations under the direction of point-of-care ultrasound (POCUS). The relatively short learning curve for providers along with excellent image quality in children due to their small size provides an easy, effective imaging modality with diverse applications. Discussed here is a broad overview of the spectrum of US use within current pediatric surgical practices.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 1","pages":"Article 151383"},"PeriodicalIF":1.7,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1055858624000040/pdfft?md5=659d67a991bd0262f3b632e976fc1f64&pid=1-s2.0-S1055858624000040-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139111467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D printing in pediatric surgery","authors":"Anthony Y. Tsai,&nbsp;Alicia C. Greene","doi":"10.1016/j.sempedsurg.2024.151385","DOIUrl":"10.1016/j.sempedsurg.2024.151385","url":null,"abstract":"<div><p>Pediatric surgery presents a unique challenge, requiring a specialized approach due to the intricacies of compact anatomy<span><span> and the presence of distinct congenital features in young patients. Surgeons are tasked with making decisions that not only address immediate concerns but also consider the evolving needs of children as they grow. The advent of three-dimensional (3D) printing has emerged as a valuable tool to facilitate a personalized medical approach. This paper starts by outlining the basics of 3D modeling and printing. We then delve into the transformative role of 3D printing in pediatric surgery, elucidating its applications, benefits, and challenges. The paper concludes by envisioning the future prospects of 3D printing, foreseeing advancements in personalized </span>treatment approaches, improved patient outcomes, and the continued evolution of this technology as an indispensable asset in the pediatric surgical arena.</span></p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 1","pages":"Article 151385"},"PeriodicalIF":1.7,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139375941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of magnets in pediatric surgery","authors":"Norah E. Liang ,&nbsp;Saunders Lin ,&nbsp;Bethany J. Slater ,&nbsp;Matias Bruzoni","doi":"10.1016/j.sempedsurg.2024.151381","DOIUrl":"10.1016/j.sempedsurg.2024.151381","url":null,"abstract":"<div><p><span>Since the 1970s, magnets have been progressively harnessed for use in minimally invasive treatment<span> of pediatric<span> surgical disease. In particular, multiple magnetic devices have been developed for treating esophageal atresia, </span></span></span>pectus excavatum<span> and scoliosis<span>. These devices, which can be placed via small incisions<span> or under endoscopic or fluoroscopic guidance, provide the added benefit of sparing patients multiple large, invasive procedures, and allowing for gradual correction of congenital anomalies over days to months, depending on the disease. In the following text, we detail the current landscape of magnetic devices used by pediatric surgeons, illustrate their use through clinical cases, and review the available body of literature with respect their outcomes and complications.</span></span></span></p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"33 1","pages":"Article 151381"},"PeriodicalIF":1.7,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139376114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children's Anaesthesia and perioperative care challenges, and innovations","authors":"Z. Gathuya ,&nbsp;M.T. Nabukenya ,&nbsp;O. Aaron ,&nbsp;R. Gray ,&nbsp;F.M. Evans","doi":"10.1016/j.sempedsurg.2023.151355","DOIUrl":"https://doi.org/10.1016/j.sempedsurg.2023.151355","url":null,"abstract":"&lt;div&gt;&lt;p&gt;The 2015 Sustainable Development Goals emphasise good health to all with reduced inequalities, and surgical and anaesthesia care is essential to achieve these. &lt;span&gt;https://sdgs.un.org/goals&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;span&gt;. However, it has been estimated that 1.7 billion children do not have access to safe anaesthesia and surgery when needed and this disproportionately affects children in low- and middle-income countries (1). It is alarming that 1 in 10 individuals in LMICs do not have access to safe surgical care. Both safe surgery and anaesthesia are essential for ensuring that individuals receive proper medical attention. Economically viable public health initiatives that can avert many disability-adjusted years are needed. (2–4)&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;span&gt;Morbidity and mortality from surgical disease and anaesthesia care remain high in low-income countries, unlike in high-income countries. The incidence of severe anaesthesia-related critical events and perioperative cardiac arrest is between three and ten times more in LMICs than in HICs (5–7) A baseline POMR that is 100 times higher in LMICs compared to HICs is reported. (8) This perioperative morbidity and mortality gap is more evident in neonates and younger age groups, especially in children with congenital abnormalities. The challenges facing providers of anaesthesia and perioperative care&lt;span&gt; are multifactorial and include but are not limited to the inadequate workforce, inadequate and inappropriate infrastructure, lack of adequate and appropriately sized equipment, including monitors, and safe monitoring capacity, supply chain challenges for medicines and reusable consumables, unreliable supply of oxygen and blood products, lack of data and research for policy formulation, inadequate resource allocation from governments and lack of safety culture among other things. In paediatrics, this is further multiplied by the variability in the sizes of the patients, from neonates to older children (9).&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;1.&lt;/span&gt;&lt;span&gt;&lt;p&gt;Improved perioperative care must include anaesthesia and nursing to improve perioperative outcomes for children.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;2.&lt;/span&gt;&lt;span&gt;&lt;p&gt;Perioperative care for children in LMICs is predominantly by non-physician anaesthesia providers or non-specialty-trained anaesthesiologists.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;3.&lt;/span&gt;&lt;span&gt;&lt;p&gt;There is a need to train physician anaesthesia leaders to direct and oversee the care of children undergoing anaesthesia&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;4.&lt;/span&gt;&lt;span&gt;&lt;p&gt;Infrastructure and equipment for the safe provision of paediatric anaesthesia/perioperative care are usually wanting/often times inadequate and inappropriate.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;5.&lt;/span&gt;&lt;span&gt;&lt;p&gt;The GICS OReCS document provides a valuable guide for the bare minimum requirements for the provision of safe paediatric anaesthetic and surgical care services, starting at the district hospital.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;6.&lt;/span&gt;&lt;span&gt;&lt;p&gt;Equipment","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"32 6","pages":"Article 151355"},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138475004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}