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Pelizzo G, Destro F, Pierucci UM, Costanzo S, Camporesi A, Diotto V, Calcaterra V, Saxena AK. Minimal Access in Pediatric Surgery: An Overview on Progress towards Dedicated Instrument Developments and Anesthesiologic Advances to Enhance Safe Completion of Procedures. CHILDREN (BASEL, SWITZERLAND) 2024; 11:679. [PMID: 38929258 PMCID: PMC11201956 DOI: 10.3390/children11060679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024]
Abstract
Surgical techniques are evolving in Pediatric Surgery, especially in the area of minimal access surgery (MAS) where indications for applications are expanding. Miniaturization of instruments, using natural orifices, single incisions, or remotely controlled robot-assisted procedures, promises to increase the benefits of MAS procedures in pediatrics. Many pediatric pathologies are rare, and specialized surgical and anesthesiologic instruments are necessary to manage them, defined as "orphan devices", for which development and dissemination on the market are slowed down or sometimes hindered by regulatory standards and limiting financial conflicts of interest. In pediatric surgery, it is of utmost importance to work in a multidisciplinary way to offer a surgical path that is safe and supported by technological advances. For this reason, optimizing pediatric anesthesia is also a crucial factor where technological advances have made monitoring more precise, thereby enhancing safety in the operative room. The development of customized instruments and technologies should be supported by pediatric research and should be adapted to the individualities of the small patient. This overview outlines the importance of dedicated instruments developed for the safe completion of MAS procedures in pediatrics.
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Affiliation(s)
- Gloria Pelizzo
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy;
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.)
| | - Francesca Destro
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.)
| | - Ugo Maria Pierucci
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.)
| | - Sara Costanzo
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.)
| | - Anna Camporesi
- Pediatric Anesthesiology and Intensive Care Unit, Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (A.C.); (V.D.)
| | - Veronica Diotto
- Pediatric Anesthesiology and Intensive Care Unit, Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (A.C.); (V.D.)
| | - Valeria Calcaterra
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Amulya K. Saxena
- Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London SW10 9NH, UK;
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Julien-Marsollier F, Loiselle M, Brouns K, Brasher C, Dahmani S. Perioperative management of surgical correction of ureteropelvic junction obstruction in children: A comparison of robotic-assisted versus conventional minimally invasive techniques. Paediatr Anaesth 2022; 32:973-975. [PMID: 35476877 DOI: 10.1111/pan.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/30/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Florence Julien-Marsollier
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2. INSERM U1141. Robert Debré University Hospital, Paris, France
| | - Maud Loiselle
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2. INSERM U1141. Robert Debré University Hospital, Paris, France
| | - Kelly Brouns
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2. INSERM U1141. Robert Debré University Hospital, Paris, France
| | - Christopher Brasher
- Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.,Anaesthesia and Pain Management Research Group, Murdoch Children 's Research Institute, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Souhayl Dahmani
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2. INSERM U1141. Robert Debré University Hospital, Paris, France
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Wang C, Liu S, Liu F, Bhutta A, Patterson TA, Slikker W. Application of Nonhuman Primate Models in the Studies of Pediatric Anesthesia Neurotoxicity. Anesth Analg 2022; 134:1203-1214. [PMID: 35147575 DOI: 10.1213/ane.0000000000005926] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Numerous animal models have been used to study developmental neurotoxicity associated with short-term or prolonged exposure of common general anesthetics at clinically relevant concentrations. Pediatric anesthesia models using the nonhuman primate (NHP) may more accurately reflect the human condition because of their phylogenetic similarity to humans with regard to reproduction, development, neuroanatomy, and cognition. Although they are not as widely used as other animal models, the contribution of NHP models in the study of anesthetic-induced developmental neurotoxicity has been essential. In this review, we discuss how neonatal NHP animals have been used for modeling pediatric anesthetic exposure; how NHPs have addressed key data gaps and application of the NHP model for the studies of general anesthetic-induced developmental neurotoxicity. The appropriate application and evaluation of the NHP model in the study of general anesthetic-induced developmental neurotoxicity have played a key role in enhancing the understanding and awareness of the potential neurotoxicity associated with pediatric general anesthetics.
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Affiliation(s)
- Cheng Wang
- From the Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, Arkansas
| | - Shuliang Liu
- From the Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, Arkansas
| | - Fang Liu
- From the Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, Arkansas
| | - Adnan Bhutta
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tucker A Patterson
- Office of the Director, National Center for Toxicological Research/FDA, Jefferson, Arkansas
| | - William Slikker
- Office of the Director, National Center for Toxicological Research/FDA, Jefferson, Arkansas
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Harte C, Ren M, Querciagrossa S, Druot E, Vatta F, Sarnacki S, Dahmani S, Orliaguet G, Blanc T. Anaesthesia management during paediatric robotic surgery: preliminary results from a single centre multidisciplinary experience. Anaesth Crit Care Pain Med 2021; 40:100837. [PMID: 33757915 DOI: 10.1016/j.accpm.2021.100837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Paediatric robotic surgery is gaining popularity across multiple disciplines and offers technical advantages in complex procedures requiring delicate dissection. To date, limited publications describe its perioperative management in children. MATERIAL & METHODS We retrospectively analysed the prospectively collected anaesthetic data of the first 200 robotic-assisted surgery procedures in our paediatric university hospital as part of a multidisciplinary program from October of 2016 to February of 2019. Anaesthetic technique and monitoring were based on guidelines initially derived from adult data. We examined adverse events and particular outcomes including blood loss and analgesic requirements. RESULTS Fifty-one different surgical procedures were performed in patients aged 4 months to 18 years (weight 5-144 kg). Operative times averaged 4 h and conversion rate was 3%. Neither robotic arm nor positional injury occurred. Limited access to the patient did not lead to any complication. Hypothermia was frequent and mostly self-limiting. Negative physiological effects due to positioning, body cavity insufflation or surgery manifesting as significant respiratory and haemodynamic changes occurred in 14% and 11% of patients, respectively. Overt haemorrhage complicated one case. Eighty per cent of 170 patients did not require level 3 analgesics postoperatively, while thoracic and certain tumour cases had greater analgesic requirements. CONCLUSION These preliminary results show that paediatric robotic surgery is well tolerated with a low bleeding risk and that major intraoperative events are uncommon. A consistent anaesthetic approach is effective across a broad range of procedures. Analgesic requirements are low excluding thoracic and some complex abdominal cases. Future studies should focus on the rehabilitative aspects of robotic surgery technique.
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Affiliation(s)
- Caroline Harte
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France.
| | - Melissa Ren
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Stefania Querciagrossa
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Emilie Druot
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Fabrizio Vatta
- Department of Paediatric Surgery and Urology, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Sabine Sarnacki
- Department of Paediatric Surgery and Urology, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France
| | - Souhayl Dahmani
- Department of Paediatric Anaesthesia and Intensive Care, Robert Debré University Hospital, AP-HP, Université de Paris, France
| | - Gilles Orliaguet
- Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France; Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Unité de recherche EA 7323, Hôpitaux Universitaires Paris centre - Site Tarnier, Université de Paris, 89 Rue d'Assas, Paris 75006, France
| | - Thomas Blanc
- Department of Paediatric Surgery and Urology, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France; Mechanisms and Therapeutic Strategies of Chronic Kidney Disease, INSERM U115-CNRS UMR 8253, Institut Necker Enfants Malades, Département "Croissance et Signalisation", Hôpital Necker Enfants Malades, Université de Paris, 149, Rue de Sèvres, Paris 75015, France
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Sellers T, Ghannam M, Asantey K, Klei J, Olive E, Roach V. Low-Cost Laparoscopic Skill Training for Medical Students Using Homemade Equipment. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10810. [PMID: 30931389 PMCID: PMC6415328 DOI: 10.15766/mep_2374-8265.10810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 01/09/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Despite the increasing prevalence of minimally invasive surgery (MIS), medical students receive little training in MIS techniques like laparoscopy. Cost is perhaps the biggest obstacle, as expensive laparoscopic skill simulators (box trainers) are needed to mimic the laparoscopic environment. Low-cost, homemade box trainers have been built and described in the literature but are generally relegated to self-directed practice for surgical residents. These do-it-yourself (DIY) box trainers are uniquely capable of addressing cost as a major barrier to laparoscopic skills training for medical students but have not previously been used specifically for this purpose. METHODS Students from the Oakland University William Beaumont School of Medicine (n = 17) participated in a laparoscopic skills training course using DIY box trainers. Four basic laparoscopic tasks were taught using live demonstrations followed by directed practice. Learners were instructed to record their first and last attempts in order to enable self-assessment of their progress. RESULTS All learners were able to successfully complete each of the four laparoscopic tasks by the end of their respective sessions. Feedback from the learners in the form of a postsession survey indicated that the course provided an enjoyable and high-quality experience. DISCUSSION This resource is effective at providing medical students with a low-cost opportunity to experience laparoscopy and develop basic laparoscopic skills.
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Affiliation(s)
- Taylor Sellers
- Medical Student, Oakland University William Beaumont School of Medicine
| | - Moleca Ghannam
- Medical Student, Student, Oakland University William Beaumont School of Medicine
| | - Kojo Asantey
- Medical Student, Oakland University William Beaumont School of Medicine
| | - Jennifer Klei
- Medical Student, Oakland University William Beaumont School of Medicine
| | - Elizabeth Olive
- Medical Student, Oakland University William Beaumont School of Medicine
| | - Victoria Roach
- Assistant Professor of Anatomy, Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine
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Ventilation, airway management, complications, perioperative anxiety: Children will definitely never be small adults. Anaesth Crit Care Pain Med 2018; 37:403-404. [PMID: 30236473 DOI: 10.1016/j.accpm.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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