“Scope and limitations of minimal invasive surgery in practice of pediatric surgical oncology.”
Bhatnagar, S. and Y. K. Sarin (2010).
Indian Journal of Medical and Paediatric Oncology 31(4): 137-142.
Management of Solid tumors in children needs a comprehensive multimodality protocol based treatment plan. Open surgical removal of the tumors occurring in any of the sites such as abdomen, thorax, chest wall, HFN (head, face, neck), brain and extremities, is the option which has been traditionally practiced even in the present era and in most of the centers. Nevertheless with the advances in science and technology and with ever increasing usage and expertise of laparoscopy in children, it’s application has extended to treatment of solid tumors in children. A review of the scope of such intervention as well as the limitations of minimal invasive surgery in this specialized field of pediatric surgery has been attempted in this article.
“Hidden Incision Endoscopic Surgery: Description of Technique, Parental Satisfaction and Applications.”
Gargollo, P. C. (2011).
Journal of Urology.
PURPOSE:: The advantages of minimally invasive surgery over open surgery in pediatrics include smaller incisions, decreased postoperative pain, reduced postoperative narcotic use, faster return to normal activity and decreased length of hospitalization. However, minimally invasive surgery with its traditional port placement leads to visible scars. To eliminate scarring, we have developed HIdES(SM), or hidden incision endoscopic surgery. MATERIALS AND METHODS:: For this technique a robotic working port, camera port and 5 mm assistant port are placed below the line of a Pfannenstiel incision. The second working 8 or 5 mm port is placed infraumbilically. The procedure is then carried out depending on the nature of the case. For this study operative times were recorded. Patients who underwent HIdES pyeloplasty or nephrectomy and their parents were asked to compare the cosmetic outcome of the trocar incisions to pictures of patients who had undergone laparoscopic surgery (pyeloplasty or nephrectomy) with traditional port placement and open surgery using validated wound and scar evaluation scales. RESULTS:: HIdES was used in 12 cases. No complications were encountered. When comparing all 3 questionnaire results for each technique used, parents and patients were statistically more satisfied with the cosmetic results after HIdES than traditional laparoscopic or open operation. CONCLUSIONS:: The HIdES technique allows all port sites to be hidden at the level of a Pfannenstiel incision, and thus renders them nonvisible if the patient is wearing a bathing suit. This approach is preferred by patients and parents alike.
“Long-Term Experience and Outcomes of Robotic Assisted Laparoscopic Pyeloplasty in Children and Young Adults.”
Minnillo, B. J., J. A. Cruz, et al. (2011).
Journal of Urology.
PURPOSE: Laparoscopic pyeloplasty is one of the more common robotic assisted procedures performed in children. However, data regarding long-term experience and clinical outcomes for this procedure are limited. We evaluated the long-term outcomes in a large series of patients undergoing robotic assisted laparoscopic pyeloplasty at a teaching institution, and the effect of a collaborative program between the robotic surgeons, surgical nurses and anesthesiologists on overall operative time. MATERIALS AND METHODS: We retrospectively reviewed 155 patients who underwent robotic assisted laparoscopic pyeloplasty between 2002 and 2009. Operative data, including surgical approach, type of procedure, total and specific operative times and placement of ureteral stents, were determined. Postoperative outcome measurements, including duration of hospital stay, duration of Foley catheter drainage, radiological findings and any subsequent complications, were assessed. RESULTS: Mean operative time and length of hospitalization decreased significantly by the end of the study. At a mean followup of 31.7 months the primary success rate was 96% (hydronephrosis was improved in 85% of patients and stable in 11%). The complication rate was 11%, and recurrent obstruction requiring redo robotic assisted laparoscopic pyeloplasty or open pyeloplasty developed in 3% of patients. Success rate and complication rate were unchanged during the study period. CONCLUSIONS: This study confirms that even within the confines of a pediatric urology training program successful collaboration between robotic surgeons, surgical nurses and anesthesiologists can lead to shorter operative times and hospital stays. Long-term surgical success and complication rates were comparable to open surgery.