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Liu J, Wang Q. Impact of surgical site infection after open and laparoscopic surgery among paediatric appendicitis patients: A meta-analysis. Int Wound J 2024; 21:e14524. [PMID: 38084057 PMCID: PMC10961035 DOI: 10.1111/iwj.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 03/25/2024] Open
Abstract
Operative site wound infection is one of the most frequent infections in surgery. A variety of studies have shown that the results of laparoscopy might be superior to those of an open procedure. Nevertheless, there is still a lack of clarity as to whether there is a difference between open and laparoscopy with respect to the occurrence of wound infections in different paediatric operations. In this review, we looked at randomized, controlled studies that directly measured the rate of wound infection following an appendectomy with a laparoscope. We looked up four main databases for randomized, controlled studies that compare the treatment of paediatric appendicitis with laparoscopy. The surgeries included appendectomy. Through our search, we have determined 323 related papers and selected five qualified ones to be analysed according to the eligibility criteria. Five trials were also assessed for the quality of the documents. In the 5 trials, there were no statistically significant differences in the incidence of post-operative wound infection among the paediatric appendectomy and the open-access group (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.34-1.15, p = 0.13). The four trials did not show any statistically significant difference in abdominal abscesses among the laparoscopic and open-access treatment groups (OR, 1.64; 95% CI, 0.90-3.01, p = 0.11). The four trials did not reveal any statistically significant difference in operating time (mean difference, -4.36; 95% CI, -17.31 to 8.59, p = 0.51). In light of these findings, the use of laparoscopy as compared with the open-approach approach in paediatric appendectomies is not associated with a reduction in the risk of wound infection.
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Affiliation(s)
- Jun Liu
- Maternal and Child Health Hospital of Hubei ProvinceTongji Medical College, Huazhong University of Science and Technology/SurgeryWuhanChina
| | - Qian Wang
- Maternal and Child Health Hospital of Hubei ProvinceTongji Medical College, Huazhong University of Science and Technology/SurgeryWuhanChina
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Vinnakota M, Bellur K, Starnes SL, Schulz MJ. Scaling a Hydraulic Motor for Minimally Invasive Medical Devices. MICROMACHINES 2024; 15:131. [PMID: 38258250 PMCID: PMC10818856 DOI: 10.3390/mi15010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
Aligned with the medical device industry's trend of miniaturization, academic and commercial researchers are constantly attempting to reduce device sizes. Many applications require miniature actuators (2 mm range) to perform mechanical work; however, biocompatible micromotors are not readily available. To that end, a hydraulic motor-driven cutting module that aims to combine cutting and drug delivery is presented. The hydraulic motor prototype developed has an outside diameter (OD) of ~4 mm (twice the target size) and a 1 mm drive shaft to attach a cutter. Four different designs were explored and fabricated using additive manufacturing. The benchtop experimental data of the prototypes are presented herein. For the prototype motor with fluid inlet perpendicular to the blades, the average angular velocity was 10,593 RPM at a flowrate of 3.6 mL/s and 42,597 RPM at 10.1 mL/s. This design was numerically modeled using 3D-transient simulations in ANSYS CFX (version 2022 R2) to determine the performance characteristics and the internal resistance of the motor. Simplified mathematical models were also used to compute and compare the peak torque with the simulation estimates. The viability of current design represents a crucial milestone in scaling the hydraulic motor to a 2 mm OD to power a microcutter.
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Affiliation(s)
- Manjeera Vinnakota
- College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH 45221, USA; (M.V.); (M.J.S.)
| | - Kishan Bellur
- College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH 45221, USA; (M.V.); (M.J.S.)
| | - Sandra L. Starnes
- College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Mark J. Schulz
- College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH 45221, USA; (M.V.); (M.J.S.)
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Alganabi M, Biouss G, Pierro A. Surgical site infection after open and laparoscopic surgery in children: a systematic review and meta-analysis. Pediatr Surg Int 2021; 37:973-981. [PMID: 33934183 DOI: 10.1007/s00383-021-04911-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
Surgical site infections (SSIs) are the most common healthcare-associated infections in patients undergoing surgery. Various randomised control trials (RCTs) indicate that laparoscopic procedures can be associated with better outcomes compared to open procedures. However, how open versus laparoscopic approaches compare across various paediatric procedures with respect to SSI rate remains poorly defined. In this review, we examined RCTs that directly compare SSI rates after open versus laparoscopic operations for appendicitis, gastro-esophageal reflux, inguinal hernia, and pyloric stenosis. MEDLINE, Embase, and Web of Science were searched for RCTs comparing four types of open versus laparoscopic operations in children. The operations included appendectomy, fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy. 364 records were identified and screened, 54 full-text articles were assessed for eligibility, and 17 RCTs were included in the analysis. SSI rate was the primary outcome. Operative time and length of stay (LOS) were the secondary outcomes. A meta-analysis was conducted using RevMan 5.4 software. Laparoscopic appendectomy had a lower SSI rate than open appendectomy (odds ratio of 2.22 [1.19, 4.15] p = 0.01). Laparoscopic fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy for pyloric stenosis were not associated with lower SSI rate compared to open surgery. Operative time was shorter in open fundoplication (- 71.22 min [- 89.79, - 52.65] p < 0.00001) than laparoscopic fundoplication. There was no significant difference in operative time of any of the other procedures. There was no significant difference in LOS between open and laparoscopic procedures for all types of operations analysed. Based on the findings of this review, it is recommended to utilise the laparoscopic approach over the open approach to reduce SSI risk in paediatric appendectomy.
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Affiliation(s)
- Mashriq Alganabi
- Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - George Biouss
- Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
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Niu X, Song X, Su A, Zhao S, Li Q. Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac: A randomized controlled study. Medicine (Baltimore) 2017; 96:e6563. [PMID: 28383434 PMCID: PMC5411218 DOI: 10.1097/md.0000000000006563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND We aimed to evaluate the effect of different capnoperitoneum pressures on stress responses in pediatric laparoscopic inguinal hernia repair. METHODS In this prospective randomized controlled study, 68 children with indirect inguinal hernia who underwent high ligation of hernia sac were randomly divided into 3 groups: high-pressure group (12 mm Hg, HP group, n = 26); low-pressure group (8 mm Hg, LP group, n = 20); open operation group (OP group, n = 22). Heart rate (HR), blood pressure, and end-tidal CO2 (PetCO2) were recorded, as well as the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) were measured by ELISAs before operation, during operation, and after operation, respectively. RESULTS After establishing capnoperitoneum, HR, blood pressure, and PetCO2 were significantly increased in the HP group compared with the OP and LP groups (P < 0.05). Comparing the intraoperatively measured ACTH and COR concentrations of the HP group to the LP group, we noted higher values in the first (P < 0.05). There was no significant difference in the postoperative concentrations of ACTH and COR among the HP, LP, and OP groups. CONCLUSIONS Laparoscopic surgery under LP capnoperitoneum or open operation may reduce stress responses and are superior to HP capnoperitoneum.
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Affiliation(s)
| | - Xubin Song
- Department of Pharmacy, Taian City Central Hospital,
| | - Aiping Su
- Department of Surgery, Taishan Hospital of Shandong Province,
| | - Shanshan Zhao
- Department of Reproductive Genetics Center, Taian City Central Hospital, Taian, China
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Ahmed H, Youssef MK, Salem EA, Fawzi AM, Desoky EAE, Eliwa AM, Sakr AMN, Shahin AMS. Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children. J Pediatr Urol 2016; 12:50.e1-5. [PMID: 26421498 DOI: 10.1016/j.jpurol.2015.05.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the slightly higher recurrence rate compared with the classic surgical repair. They have the advantage of easy and precise identification of the type of defect and its correction, both in ipsilateral and contralateral sides. OBJECTIVES The objectives of this study were to evaluate the efficacy, safety and outcome of the laparoscopically assisted piecemeal high ligation of a patent processus vaginalis (PPV) in children. METHODS A total of 40 children were enrolled into this prospective study; they were aged ≥ 6 months and had an inguinal hernia. The peritoneal cavity, including the contralateral side, was inspected for the possibility of bilateral hernias using a 3-mm 30° telescope. Another 3-mm port was introduced through the same infra-umbilical incision. The hernia was manually reduced or with the aid of a working infra-umbilical grasper. A prolene or vicryl 2/0 or 3/0 suture on a curved semicircle round-bodied taper-ended 25-30 mm needle was introduced through a very small inguinal skin-crease incision. It was passed through the abdominal wall layers to the peritoneum and was manipulated by the laparoscopic grasper to pick up the peritoneum in piecemeal all around the internal ring. The needle was then pushed to the outside near to the entrance site, thus forming a semicircle around the internal ring. The suture was then tied and the knot was subcutaneously buried. The primary outcome of the procedure was the incidence of intraoperative diagnosis and surgical repair of contralateral hernias in pre-operatively diagnosed unilateral cases. The secondary outcomes were defined as the incidence of complications and hernia recurrence. DISCUSSION The exploratory laparoscopy found contralateral patent processus vaginalis (CPPV) with a detection rate of 28.1%. Chan et al., Esposito et al., Toufique et al. and Niyogi et al. reported similar figures for laparoscopic contralateral hernia detection rates of 28%, 39%, 39.7% and 29.2%, respectively. The limitations of this study were the small sample size, plus the risk factors and clinical significance for CPPV. CONCLUSION Laparascopically assisted piecemeal closure of the internal inguinal ring in children is a safe and effective procedure. It helps in detecting a contralateral hernia without prolonging the operative time.
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Affiliation(s)
- H Ahmed
- Benha University, Faculty of Medicine, Dept. of General Surgery, Egypt.
| | - M K Youssef
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - E A Salem
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - A M Fawzi
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - E A E Desoky
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - A M Eliwa
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - A M N Sakr
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - A M S Shahin
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
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Duarte RJ, Dénes FT, Cristofani LM, Srougi M. Laparoscopic nephrectomy for Wilms’ tumor. Expert Rev Anticancer Ther 2014; 9:753-61. [DOI: 10.1586/era.09.44] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Denholm B, Burlingame B. Clinical Issues—July 2010. AORN J 2010. [DOI: 10.1016/j.aorn.2010.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Metzelder ML, Kuebler JF, Huber D, Vieten G, Suempelmann R, Ure BM, Osthaus WA. Cardiovascular responses to prolonged carbon dioxide pneumoperitoneum in neonatal versus adolescent pigs. Surg Endosc 2009; 24:670-4. [DOI: 10.1007/s00464-009-0654-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 06/25/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022]
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Rigid NOTES: The Transurethral Approach in Female Piglets. J Laparoendosc Adv Surg Tech A 2009; 19:581-7. [DOI: 10.1089/lap.2009.0105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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