Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence

Kiblawi, Rim; Zoeller, Christoph; Zanini, Andrea; Ure, Benno M.; Dingemann, Jens; Kuebler, Joachim F.; Schukfeh, Nagoud

doi:10.1055/s-0040-1716878

Cited by 23 publications

(19 citation statements)

References 70 publications

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“…It has been numerously postulated that despite the use of minimally invasive techniques in almost all pediatric surgical units all over the globe, high level of evidence concerning advantages and disadvantages of laparoscopy remains scarce. 13 14 251 We confirm a lack of RCTs. Indeed only 26 RCTs were published during the past 30 years dealing with abdominal procedures in children.…”

Section: Discussionsupporting

confidence: 51%

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

et al. 2021

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Introduction Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. We reviewed the literature on studies published in the last three decades and dealing with advantages and disadvantages of laparoscopy compared to open surgery. Materials and Methods Studies comparing laparoscopic versus open abdominal procedures in children were searched in PubMed/MEDLINE. Reports on upper and lower gastrointestinal as hepatobiliary surgery and on surgery of pancreas and spleen were included. Advantages and disadvantages of laparoscopic surgery were analyzed for different types of procedures. Complications were categorized using the Clavien–Dindo classification. Results A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien–Dindo grade I to III complications (mild–moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency of reporting on advantages after laparoscopy and increased reporting on disadvantages for all surgery types over the decades. Conclusion Laparoscopic compared with open pediatric surgery seems to be beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.

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Section: Discussionsupporting

confidence: 51%

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

et al. 2021

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“…Today, minimally invasive repair of CDH is commonly accepted for selected patients. 38 Only one patient developed vena cava thrombosis after minimally invasive CDH repair, no significance was found between operative approach and development of vena cava thrombosis. In the literature, the correlation between surgical approach and development of vena cava thrombosis has not been investigated.…”

Section: Discussionmentioning

confidence: 86%

Vena Cava Thrombosis after Congenital Diaphragmatic Hernia Repair: Multivariate Analysis of Potential Risk Factors

et al. 2021

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Introduction The treatment of newborns with congenital diaphragmatic hernia (CDH) is associated with a significant complication rate. Information on major thrombotic complications and their incidence in newborns with CDH is lacking. The aims of our analysis were to evaluate the frequency of vena cava thrombosis and to determine its predictors within a consecutive series of patients with CDH. Materials and Methods We retrospectively analyzed charts of all neonates of our department that underwent CDH repair from 2007 to 2021, focusing on vena cava thrombosis. Vena cava thrombosis was diagnosed sonographically and classified as complete or partial venous occlusion. Complete occlusion was confirmed by cavography. Variables evaluated were CDH side, liver position, central vein line, surgical approach, and extracorporeal membrane oxygenation (ECMO). Univariate and multivariate tests were utilized. Results Among 57 neonates who underwent CDH repair, vena cava thrombosis was diagnosed in 14 (24.6%), seven of whom had complete occlusion of the vena cava. Factors associated with vena cava thrombosis were femoral or saphenous venous catheter (p = 0.044), right sided CDH (p = 0.027) and chylothorax (p < 0.0001). ECMO was not associated with vena cava thrombosis. Seven patients (50%) with vena cava thrombosis were treated interventionally with angioplasty and seven (50%) conservatively with anticoagulation only. Mortality was not higher in patients with compared with patients without vena cava thrombosis. Conclusion The incidence of vena cava thrombosis in newborns with CDH in our series is high. Routine postoperative abdominal sonography focusing on vena cava thrombosis is mandatory in all patients with CDH. Patients who developed vena cava thrombosis were more likely to develop chylothorax after CDH repair. Considering the good outcome of medical therapy of partial vena cava thrombosis, it may be discussed whether low dose anticoagulation may be provided to all newborns with CDH.

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“…In the pediatric population, video-assisted thoracoscopic surgery (VATS) seems to have many advantages when compared with traditional thoracic surgery. Nonetheless, the level of evidence is not high enough [29]. Further, robotic-assisted thoracoscopic surgery (RATS) in children presents several technical di culties for neonatal surgeries in particular.…”

Section: Discussionmentioning

confidence: 99%

Robotic-Assisted Surgery in Pediatrics: What Is Evidence-Based? A Review of the Literature

Boscarelli

Giglione

Caputo

et al. 2022

Preprint

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Aim of the study: This study examines evidence-based indications for robotic-assisted surgery (RAS) in the different fields of pediatric surgery.Methods: A systematic database search (MEDLINE, Scopus, Web of Science) was performed to identify articles covering any aspect of RAS in the pediatric population. Using Boolean operators AND/OR, all possible combinations of the following search terms were used: robotic surgery, pediatrics, neonatal surgery, thoracic surgery, abdominal surgery, urologic surgery, hepatobiliary surgery, and surgical oncology. The selection criteria were limited to the English language, pediatric patients (under 18 years of age), and articles published after 2010.Main Results: A total of 239 abstracts were reviewed. Of these, 10 published articles met the purposes of our study with a level of evidence I/II and therefore were analyzed. Notably, most of the articles included in this review reported evidence-based indications in urological surgery.Conclusions: According to this study, the exclusive indications for RAS in the pediatric population are pyeloplasty for ureteropelvic junction obstruction in older children and ureteral reimplantation according to the Lich-Gregoire technique in selected cases for the need to access the pelvis with a narrow anatomical and working space. All other indications for RAS in pediatric surgery are still under discussion to date, and cannot be supported by papers with a high level of evidence. However, RAS is certainly a promising technology. Further evidence is strongly encouraged in the future.

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Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence

Cited by 23 publications

References 70 publications

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

Vena Cava Thrombosis after Congenital Diaphragmatic Hernia Repair: Multivariate Analysis of Potential Risk Factors

Robotic-Assisted Surgery in Pediatrics: What Is Evidence-Based? A Review of the Literature

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