The risks of minimal access surgery in children: an aid to consent

Adikibi, Boma T.; MacKinlay, Gordon A.; Clark, M.C.; Duthie, Gillian; Munro, Fraser D.

doi:10.1016/j.jpedsurg.2011.12.009

Cited by 14 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[26–28] However, visceral injury [29] and trocar site herniation [30] have been noted as disadvantages of MIS. With regard to safety, tumor spillage or trocar site recurrence should always be a concern.…”

Section: Discussionmentioning

confidence: 99%

Abdominal tumors in children

Youn

Han

et al. 2016

Medicine

View full text Add to dashboard Cite

The use of minimally invasive surgery (MIS) in pediatric patients has been steadily increasing in recent years. However, its use for diagnosing and treating abdominal tumors in children is still limited compared with adults, especially when malignancy is a matter of debate. Here, we describe the experience at our center with pediatric abdominal tumors to show the safety and feasibility of MIS.Based on a retrospective review of patient records, we selected for study those pediatric patients who had undergone diagnostic exploration or curative resection for abdominal tumors at a single center from January 2010 through August 2015.Diagnostic exploration for abdominal tumors was performed in 32 cases and curative resection in 173 cases (205 operations). MIS was performed in 11 cases of diagnostic exploration (34.4%) and 38 cases of curative resection (21.9%). The mean age of the children who underwent MIS was 6.09 ± 5.2 years. With regard to diagnostic exploration, patient characteristics and surgical outcomes were found to be similar for MIS and open surgery. With regard to curative resection, however, the mean age was significantly lower among the patients who underwent open surgery (4.21 ± 4.20 vs 6.02 ± 4.99 for MIS, P = 0.047), and the proportion of malignancies was significantly higher (80% vs 39.4% for MIS, P < 0.001). MIS compared favorably with open surgery with respect to the rate of recurrence (6.7% vs 35.1%, P = 0.035), the rate of intraoperative transfusions (34.2% vs 58.5%, P = 0.01), the median amount of blood transfused (14 vs 22 mL/kg, P = 0.001), and the mean number of hospital days (4.66 ± 2.36 vs 7.21 ± 5.09, P < 0.001). Complication rates did not differ significantly between the MIS and open surgery groups. The operation was converted to open surgery in 3 cases (27.2%) of diagnostic MIS and in 5 cases (13.1%) of curative MIS.MIS was found to be both feasible and effective for the diagnosis and curative treatment of pediatric abdominal tumors. However, to determine the surgical role and guidelines for MIS for each specific tumor, a multicenter prospective study with a long-term follow-up is warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Abdominal tumors in children

Youn

Han

et al. 2016

Medicine

View full text Add to dashboard Cite

show abstract

“…When broken into subgroups, it was 3.9, 1.3, and 10% in gastrointestinal, genitourinary, and thoracic cases, respectively ( 4 ). This is comparable to the conversion rate in conventional pediatric minimally invasive surgery ( 20 ). However, the real conversion rate for robotic pediatric surgery may be higher due to citation bias.…”

Section: Safetymentioning

confidence: 53%

Robotic Surgery may Not â€œMake the Cutâ€ in Pediatrics

2015

View full text Add to dashboard Cite

Since the introduction of robotic surgery in children in 2001, it has been employed by select pediatric laparoscopic surgeons, but not to the degree of adult surgical specialists. It has been suggested that the technical capabilities of the robot may be ideal for complex pediatric surgical cases that require intricate dissection. However, due to the size constraints of the robot for small pediatric patients, the tight financial margins that pediatric hospitals face, and the lack of high level data displaying patient benefit when compared to conventional laparoscopic surgery, it may be some time before the robotic surgical platform is widely embraced in pediatric surgical practice.

show abstract

“…When broken into subgroups, it was 3.9%, 1.3%, and 10% in gastrointestinal, genitourinary, and thoracic cases, respectively (Cundy et al 2013). This is comparable to the conversion rate in conventional pediatric minimally invasive surgery (Adikibi et al 2012). However, the real conversion rate for robotic pediatric surgery may be higher due to citation bias.…”

Section: Safetymentioning

confidence: 76%

Innovations in Minimally Invasive Surgery in Children

Ponsky¹,

Falk²

2016

Pediatric Surgery

View full text Add to dashboard Cite

This chapter provides an overview of recent innovations in pediatric minimally invasive surgery that have enabled pediatric surgeons to operate safely on their smallest patients through tiny incisions. The development of size appropriate laparoscopes and instruments has been key in the development of this specialty. We also discuss NOTES, telemedicine, and robotic surgery in our pediatric population. The numerous MIS techniques, originally used in the adult population, have been successfully applied to our pediatric patients. MIS has become routine for the treatment of many pediatric surgical disease processes, due to the numerous benefits these techniques confer on the patient: decreased wound complications, shorter length of stay, and improved postoperative pain. Inherent in the application of these complex techniques to infants and children are many risks due to the size of these patients. Pediatric surgeons must be aware and understand these risks if they are to successfully and safely practice MIS. MIS will continue to develop as long as industry is committed to developing pediatric equipment to provide better care for our patients. Surgical training must continue to evolve, to ensure that the next generation of surgeons is adequately trained in these complex techniques. The future of pediatric MIS is exciting for our patients and indeed the specialty of pediatric surgery.

show abstract

The risks of minimal access surgery in children: an aid to consent

Cited by 14 publications

References 20 publications

Abdominal tumors in children

Abdominal tumors in children

Robotic Surgery may Not â€œMake the Cutâ€ in Pediatrics

Innovations in Minimally Invasive Surgery in Children

Contact Info

Product

Resources

About

The risks of minimal access surgery in children: an aid to consent

Cited by 14 publications

References 20 publications

Abdominal tumors in children

Abdominal tumors in children

Robotic Surgery may Not â€œMake the Cutâ€ in Pediatrics

Innovations in Minimally Invasive Surgery in Children

Contact Info

Product

Resources

About

Robotic Surgery may Not â€œMake the Cutâ€ in Pediatrics