Safety Assessment for Thoracoscopic Day Case Surgery in Children with Congenital Pulmonary Malformation

Mariani, Aurora; Peycelon, Matthieu; Clermidi, Pauline; Bellon, Myriam; Skhiri, Alia; Bonnard, Arnaud

doi:10.1089/lap.2017.0721

Cited by 5 publications

(5 citation statements)

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“…24 The complication rate and recurrence are comparable, but the mean age of the patients is statistically higher for ERATS compared with thoracoscopic procedures, 25 as are the operative time and the duration of the hospital stay. 26 This indication accounted for 38% of the cases in our series. Although cyst resection does not require specific technical skills, this indication appears to be more suitable for robotic surgery, particularly when closure of the esophagus is needed in case of the occurrence of a mucosal perioperative perforation.…”

Section: Discussionmentioning

confidence: 68%

“…A thoracic approach typically requires the placement of trocars between the costal arches. The use of 5-mm and even 3mm trocars has by now been thoroughly assessed, and this has become widespread for standard thoracoscopic procedures, 26 with a high level of feasibility. Eight-millimeter trocars are too large for use in the newborn intercostal space, and this is more The Potential and the Limitations of Esophageal Robotic Surgery in Children Ferrero et al…”

Section: Esophagoplastymentioning

confidence: 99%

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The Potential and the Limitations of Esophageal Robotic Surgery in Children

et al. 2020

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Introduction There have been numerous reports of robotic pediatric surgery in the literature, particularly regarding urological procedures for school-aged children. Thoracic procedures appear to be less common, despite the fact that encouraging results were reported more than 10 years. Our aim was to report a national experience of esophageal robotic-assisted thoracoscopic surgery (ERATS) and to discuss the most appropriate indications. Materials and Methods A retrospective multicenter study was conducted to compile the ERATS performed at five French surgical centers that have been involved in spearheading robotic pediatric surgery over the past 15 years. The data were supplemented by a review of the literature. Results Over the study period, 68 cases of robotic thoracic surgery were performed at the five pediatric centers in question. ERATS was performed for 18 patients (mean age 7.1 years [ ± 5.6]) in four of the centers. These comprised seven esophageal duplications, four esophageal atresias, five Heller's myotomies, and two cases of esophagoplasty. A conversion was needed for two neonates (11%) due to exposure difficulties. Four other procedures for patients who weighed less than 15 kg were successfully completed without causing postoperative complications. In the past 12 years, 22 other cases of ERATS were published worldwide. The indications were the same, except for esophagoplasty, which was not found. Conclusion Aside from accessibility issues with the robotic platform, the main limitation is still very much that the low body weight of children results in incompatibility between the size of the trocars and the size of the intercostal space. ERATS is clearly a feasible procedure with technical advantages for most pediatric cases with body weights more than 15 kg. A transdiaphragmatic abdominal approach should be considered for lower esophagus surgery.

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Section: Discussionmentioning

confidence: 68%

Section: Esophagoplastymentioning

confidence: 99%

The Potential and the Limitations of Esophageal Robotic Surgery in Children

et al. 2020

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“…There are many studies stating the benefits of ambulatory breast surgery in only PVB or in combination with general anaesthesia ( 10 , 11 , 14 , 22 ). There is also a significantly present application of PVB in day surgery of inguinal hernia repair in both children and adults, in lithotripsy, video assisted thoracic surgery, gall bladder removal and chronic pain therapy ( 7 , 9 , 10 , 13 , 15 - 18 , 23 ). Depending on the type of surgery and expected postoperative analgesic requirement, PVB is applied either unilaterally, bilaterally or with a catheter insertion technique for continued postoperative analgesia ( 8 , 10 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…Bilateral application is most commonly a single shot technique on two levels, depending on the type of surgery, in order to avoid potential complications (local anaesthetic toxicity and haemodynamic instability) ( 5 , 8 , 10 , 12 , 25 ). Unilateral application is used in breast surgery, thoracic surgery, cardiac pacemaker insertion, rib fractures, open cholecystectomy, liver resections, oesophageal and gastric surgery, partial or complete nephrectomies, inguinal herniorraphy ( 5 , 7 , 8 , 10 , 12 , 13 , 15 - 18 , 23 ). Bilateral application is used in cardiac surgery, oesophageal surgery, umbilical hernia repair, pelvic surgery, vaginal delivery, prostatectomy and hysterectomy ( 5 , 8 , 10 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

The Role of Paravertebral Blocks in Ambulatory Surgery: Review of the Literature

Župčić

Dedić

Župčić

et al. 2019

ACC

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SUMMARYAmbulatory surgery often involves surgical procedures on the thorax, abdomen and limbs, which can be associated with substantial postoperative pain. The aim of this narrative review is to provide an analysis of the effectiveness of paravertebral block (PVB) alone or in combination with general anaesthesia, in this setting, with an emphasis on satisfactory postoperative analgesia in comparison to other modalities. We have conducted a search of current medical literature written in English through PubMed, Google Scholar and Ovid Medline®. Peer-reviewed professional articles, review articles, retrospective and prospective studies, case reports and case series were systematically searched for during the time period between November 2003 and February 2019. The literature used for the purpose of creating this review showed that utilisation of paravertebral block either alone or in combination with general anaesthesia, has a positive effect on satisfactory analgesia in ambulatory surgery. With a multimodal analgesic approach of PVB and other techniques of anaesthesia and analgesia there is a reduction in postoperative opioid consumption, fewer side effects, lower pain scores, decreased mortality, earlier mobilisation of patients and reduced hospital stay.

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“…As the success of standardized outpatient procedures has become evident, the implementation of ambulatory models in pediatric surgery is an exciting development [5]. This practice has previously been reported for various diseases, showing promise in improving patient experiences and overall healthcare delivery.…”

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights

Pio,

Tulelli,

Ali

et al. 2023

Children

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Background: Same-day discharge after a cholecystectomy is a common practice in the adult population and has been demonstrated as safe and viable for children as well. However, there is a lack of comprehensive teaching models for pediatric cholecystectomy. Drawing inspiration from standardized outpatient procedures, this study aimed to assess the clinical outcomes and feasibility of teaching programs and an Enhanced Recovery After Surgery (ERAS) protocol following ambulatory laparoscopic cholecystectomy in pediatric patients. Methods: In 2015, an ERAS pathway for laparoscopic cholecystectomy (LC) was implemented, focusing on admission procedures, surgery timing, anesthetic choices, analgesia, postoperative feeding, mobilization, and pain assessment. Day-case surgery was not applicable for acute cholecystitis, choledochal lithiasis, sickle cell disease, and hereditary spherocytosis cases. The protocol was employed for a group of attending surgeons and fellows, as well as a group of residents under the supervision of experienced surgeons. A retrospective analysis was conducted to evaluate the feasibility and effectiveness of ambulatory cholecystectomy in children and its utilization in training pediatric surgical trainees. Results: Between 2015 and 2020, a total of 33 patients were included from a cohort of 162 children who underwent LC, with 15 children operated on by senior surgeons and 18 by young surgeons. The primary diagnoses were symptomatic gallbladder lithiasis (n = 32) and biliary dyskinesia (n = 1). The median age at the time of surgery was 11.3 years (interquartile range (IQR) 4.9–18), and the median duration of surgery was 54 min (IQR 13–145). One intraoperative complication occurred, involving gallbladder rupture and the dissemination of lithiasis into the peritoneal cavity. Three patients (9%) required an overnight stay, while no postoperative complications or readmissions within 30 days were observed. ERAS was successfully implemented in 30 patients (91%). No significant differences in surgical outcomes were noted between senior and young surgeons. At an average follow-up of 55 months, no long-term sequelae were identified. Conclusions: These findings align with the current trend of increasing use of outpatient laparoscopic cholecystectomy and underscore its feasibility in the pediatric population. The application of a structured ERAS protocol appears viable and practical for training the next generation of pediatric surgeons. Level of Evidence: Level III.

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Safety Assessment for Thoracoscopic Day Case Surgery in Children with Congenital Pulmonary Malformation

Abstract: This first analysis of a small monocentric dataset demonstrates that pediatric patients can safely undergo thoracoscopy, an outpatient procedure, with a high rate of parental satisfaction.

Cited by 5 publications

References 38 publications

The Potential and the Limitations of Esophageal Robotic Surgery in Children

The Potential and the Limitations of Esophageal Robotic Surgery in Children

The Role of Paravertebral Blocks in Ambulatory Surgery: Review of the Literature

Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights

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