1
|
Traynor MD, Brar GD, Bruno FP, Iyer G, Ishitani MB. Pulmonary Metastasectomy in Pediatric Patients: A Comparison of Open and Thoracoscopic Approaches. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34783259 DOI: 10.1089/lap.2021.0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Although the use of video-assisted thoracoscopic surgery (VATS) for resection of lung metastases has increased, surgeons still advocate for open resection as it permits palpation of lesions that may be missed on imaging. This study aimed to compare the utilization of open thoracotomy versus VATS over time and determine if the use of VATS changes perioperative outcomes. Methods: Using the Kids' Inpatient Database (2006, 2009, 2012, 2016), we identified children (age ≤20) with a diagnosis of secondary lung cancer with either lobectomy or sublobar resection coded during the same admission. Utilization was compared across years for the overall cohort and for patients with primary bone and connective tissue (PBCT) cancers. We defined prolonged length of stay (LOS) as LOS ≥75th percentile (LOS ≥7 days). Univariable and multivariable analyses compared in-hospital complication rates and LOS for open and VATS approaches. Results: Of the 1316 children (539 female) undergoing pulmonary resection, VATS was utilized in 374 (28.4%). Utilization increased rapidly from 2006 to 2009 (P < .001 for trend), but stabilized thereafter (P = .622). Metastatic PBCT cancers were the most common indication for resection (n = 496, 38%), but open and VATS approaches were used nearly equally (P = .368). Overall, 352 (26%) patients had complications. On multivariable analysis, the open approach remained independently associated with increased complications (odds ratio [OR] 1.48, 95% confidence interval [CI] [1.04-2.11]). Median LOS increased for open cases (5 versus 3 days, P < .001). Furthermore, open metastasectomy was associated with prolonged LOS (OR 1.50, [1.07-2.10]) after controlling for age, sex, primary cancer, reporting year, resection extent, obesity, complications, and nonoperative intubation. Conclusion: VATS approach to pulmonary metastasectomy resulted in fewer complications and shorter LOS in a nationwide sample of children. Despite these advantages, the use of VATS has plateaued. While this study cannot comment on oncologic safety or long-term outcomes, future studies should evaluate whether indications for VATS pulmonary metastasectomy can be expanded.
Collapse
Affiliation(s)
- Michael D Traynor
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
- TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- This article was presented virtually during the Prize plenary session at the 53rd Annual Pacific Association of Pediatric Surgeons Meeting on November 10, 2020
| | - Gurbir Dimple Brar
- TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Markham Stouffville Hospital, Markham, Ontario, Canada
- This article was presented virtually during the Prize plenary session at the 53rd Annual Pacific Association of Pediatric Surgeons Meeting on November 10, 2020
| | - Fernando P Bruno
- TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Anatomy, Touro College of Osteopathic Medicine, New York, New York, USA
- This article was presented virtually during the Prize plenary session at the 53rd Annual Pacific Association of Pediatric Surgeons Meeting on November 10, 2020
| | - Geetha Iyer
- TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- This article was presented virtually during the Prize plenary session at the 53rd Annual Pacific Association of Pediatric Surgeons Meeting on November 10, 2020
| | - Michael B Ishitani
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
- This article was presented virtually during the Prize plenary session at the 53rd Annual Pacific Association of Pediatric Surgeons Meeting on November 10, 2020
| |
Collapse
|
2
|
CT-guided hook-wire localization of pulmonary nodules in children prior to atypical resection by thoracoscopy: Practical aspects. RADIOLOGIA 2021; 63:415-424. [PMID: 34625197 DOI: 10.1016/j.rxeng.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022]
Abstract
In the multidisciplinary treatment of pediatric oncologic patients, multiple imaging tests, biopsies, and resections are required for diagnosis, initial staging, and posterior restaging. In these patients, pulmonary nodules are not always metastases, so the correct diagnosis of these lesions affects their treatment and the patient's survival. Percutaneous localization of pulmonary nodules is key for two reasons: it enables the surgeon to resect the smallest amount of lung tissue possible and it guarantees that the nodule will be included in the resected specimen. Without percutaneous localization, it can be impossible to accomplish these two objectives in patients with very small nodules that are separated from the pleural surface and therefore impossible to see by thoracoscopy. This article reviews the technique for hook-wire localization of pulmonary nodules and the keys to ensuring the best results.
Collapse
|
3
|
Gallego-Herrero C, López-Díaz M, Coca-Robinot D, Cruz-Conde M, Rasero-Ponferrada M. Localización de nódulos pulmonares con arpón guiado con TC para resección atípica por toracoscopia en pacientes pediátricos: aspectos prácticos. RADIOLOGIA 2021. [DOI: 10.1016/j.rx.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
4
|
Sheikh F, Brandt RJ, Tsapakos MJ, Baertschiger RM, Croitoru DP. CT-guided blood tattoo for thoracoscopic excision of lung lesions in pediatric patients. J Thorac Dis 2020; 12:4284-4291. [PMID: 32944340 PMCID: PMC7475583 DOI: 10.21037/jtd-19-3800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To describe a single-institutional experience with an innovative technique using CT-guided injection of autologous blood for localization of nonpleural-based pulmonary nodules prior to thoracoscopic excisional biopsy in pediatric patients. Methods A retrospective review of all patients under the age of 18 with lung lesions suspected to be malignant that were not pleural-based lesions and were not of adequate size to visualize at thoracoscopy, who underwent CT-guided blood tattoo (CGBT) localization between 2006-2019. CGBT was performed under general anesthesia by injecting 0.5-10 mL of autologous blood into the area of the lesions. The patients were then immediately transferred from interventional radiology to the operating room for thoracoscopic excision of the lesion. Demographics, location of lesions, indication for biopsy, and pathology were reviewed. Results In eleven pediatric patients (ages ranging from 4-18 years), preoperative CGBT localization of pulmonary nodules resulted in successful thoracoscopic excisional biopsy. All resections were diagnostic and 82% (9/11 cases) represented a metastatic malignancy as confirmed by pathology. Malignant nodules ranged from 2 to 14 mm in size, while a 13 mm nodule in a patient with history of AML was determined to be an organizing pneumonia and a 12 mm nodule in a second patient revealed a caseating granuloma consistent with Crohn's disease. One patient with a failed attempt at excisional biopsy without preoperative localization then underwent CGBT one week later with successful thoracoscopic excision of the nodule. Conclusions CT-guided blood tattoo is a safe option for localization of nonpleural-based lung nodules prior to thoracoscopic excision in pediatric patients.
Collapse
Affiliation(s)
- Fariha Sheikh
- Department of Surgery, Division of Pediatric Surgery, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ryan J Brandt
- Department of Radiology, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael J Tsapakos
- Department of Radiology, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Reto M Baertschiger
- Department of Surgery, Division of Pediatric Surgery, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Daniel P Croitoru
- Department of Surgery, Division of Pediatric Surgery, Abdominal Imaging Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
5
|
Christison-Lagay ER, Thomas D. Minimally Invasive Approaches to Pediatric Solid Tumors. Surg Oncol Clin N Am 2018; 28:129-146. [PMID: 30414678 DOI: 10.1016/j.soc.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Over the last decade, driven in part by the favorable adult experience and a crescendoing number of case series and retrospective reports in the pediatric surgical literature, minimally invasive surgical (MIS) approaches are increasingly used as adjunctive or definitive surgical treatments for an ever-expanding list of pediatric tumors. Although most current treatment protocols lack surgical guidelines regarding the use of MIS, this growing body of MIS literature provides a framework for the development of multicenter trial groups, prospective registries, and further centralization of subspecialist services. This article highlights the current available data on MIS approaches to a variety of pediatric malignancies.
Collapse
Affiliation(s)
- Emily R Christison-Lagay
- Department of Surgery, Section of Pediatric Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT 06520, USA.
| | - Daniel Thomas
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, FMB 107, New Haven, CT 06520, USA
| |
Collapse
|
6
|
Souzaki R, Kawakubo N, Miyoshi K, Obata S, Kinoshita Y, Takemoto J, Kohashi K, Oda Y, Taguchi T. The Utility of Muscle-Sparing Axillar Skin Crease Incision with Thoracoscopic Surgery in Children. J Laparoendosc Adv Surg Tech A 2018; 28:1378-1382. [PMID: 29920140 DOI: 10.1089/lap.2018.0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Thoracoscopic surgery for pediatric benign tumors is a common procedure. However, a large incision is needed to remove large tumors from the thoracic cavity. And, for intrapulmonary sequestration in lower lobe, it sometimes needs a large incision to ligate the aberrant vessels. A muscle-sparing axillar skin crease incision (MSASCI) has been introduced for thoracic open surgery, resulting in excellent aesthetic outcomes compared with a standard incision. We herein report the utility of this MSASCI technique in thoracoscopic surgery to remove large tumors from the thoracic cavity and to ligate the aberrant vessels in intrapulmonary sequestration in lower lobe. MATERIALS AND METHODS From 2014 April to 2016 March, we performed the MSASCI technique in thoracoscopic surgeries for 5 children. RESULT Five cases were diagnosed as mediastinal masses (mature teratoma for 1 case, ganglioneuroblastoma for 2 cases, and extrapulmonary sequestration and intrapulmonary sequestration for 1 case each). The age at surgery was 32.0 ± 25.0 months (range 5-58 months). The size of the mediastinal mass was 9 × 5 × 5 cm, 4 × 3 × 3 cm, 5 × 5 × 2.5 cm, and 3 × 2.5 × 2 cm. For 4 other cases, except for the intrapulmonary sequestration case, the mass was resected under thoracoscopic surgery using only three or four 5-mm trocars and the mass was removed from the thoracic cavity using the MSASCI technique. For the intrapulmonary sequestration case, the aberrant vessels were resected under thoracoscopic surgery using only two 5-mm and one 12-mm trocars and the left lower lobectomy was performed using the MSASCI technique. All lesions were resected completely. No cases had surgical complications, none showed recurrence, and all cases demonstrated good cosmetic outcomes. CONCLUSIONS Performing thoracoscopic surgery using a MSASCI technique is associated with good cosmetic outcome.
Collapse
Affiliation(s)
- Ryota Souzaki
- 1 Department of Pediatric Surgery, Faculty of Medical Sciences, Reproductive and Developmental Medicine, Kyushu University , Fukuoka, Japan
| | - Naonori Kawakubo
- 1 Department of Pediatric Surgery, Faculty of Medical Sciences, Reproductive and Developmental Medicine, Kyushu University , Fukuoka, Japan
| | - Kina Miyoshi
- 1 Department of Pediatric Surgery, Faculty of Medical Sciences, Reproductive and Developmental Medicine, Kyushu University , Fukuoka, Japan
| | - Satoshi Obata
- 1 Department of Pediatric Surgery, Faculty of Medical Sciences, Reproductive and Developmental Medicine, Kyushu University , Fukuoka, Japan
| | - Yoshiaki Kinoshita
- 1 Department of Pediatric Surgery, Faculty of Medical Sciences, Reproductive and Developmental Medicine, Kyushu University , Fukuoka, Japan
| | - Junkichi Takemoto
- 2 Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University , Fukuoka, Japan
| | - Kenichi Kohashi
- 2 Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University , Fukuoka, Japan
| | - Yoshinao Oda
- 2 Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University , Fukuoka, Japan
| | - Tomoaki Taguchi
- 1 Department of Pediatric Surgery, Faculty of Medical Sciences, Reproductive and Developmental Medicine, Kyushu University , Fukuoka, Japan
| |
Collapse
|
7
|
McDaniel JD, Racadio JM, Patel MN, Johnson ND, Kukreja K. CT-guided localization of pulmonary nodules in children prior to video-assisted thoracoscopic surgical resection utilizing a combination of two previously described techniques. Pediatr Radiol 2018; 48:626-631. [PMID: 29362842 DOI: 10.1007/s00247-018-4069-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 12/01/2017] [Accepted: 01/03/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Pulmonary nodules in pediatric oncology patients can present a diagnostic and treatment dilemma. Imaging findings are often nonspecific and tissue diagnosis may be required for appropriate treatment. The smaller subpleural nodules may not be visualized and cannot be palpated during video-assisted thoracoscopic surgical (VATS) resection. Preoperative localization has been beneficial in obtaining an adequate pathological specimen. OBJECTIVE This study presents experience in a large pediatric hospital using CT-guided preoperative localization of pulmonary nodules combining two previously utilized techniques, hook wire and methylene blue blood patch localization. MATERIALS AND METHODS A search of the electronic medical record utilizing a medical record search application was performed to identify all patients who underwent preoperative lung nodule localization during a 12.5-year period (July 1999 through January 2012). A retrospective chart review of these patients was then performed. Pre- and postoperative imaging, interventional radiology procedural images and reports, surgical reports, and pathology reports were obtained and evaluated. RESULTS Thirty-five patients, with 40 nodules, who underwent preoperative CT-guided lung nodule localization were identified. Patients ranged in age from 8 months to 21 years. The pulmonary nodules ranged in size from 1.4 mm to 18 mm. Twelve nodules were localized using a Kopans breast lesion localization needle with hook wire, 4 were localized using a methylene blue blood patch, and 24 were localized using the combination of these two techniques. The technical success rate of all procedures was 100%. A pathological diagnosis was determined in 39 patients (97.5%). There were 6 (15.0%) minor complications and no major complications. CONCLUSION CT-guided lung nodule localization using the combined techniques of methylene blue blood patch and hook wire is safe, technically feasible and successful in children. Using this combination of techniques will consistently yield a pathological diagnosis, is currently the preferred technique at our tertiary pediatric hospital and could be considered the new best practice.
Collapse
Affiliation(s)
- Janice D McDaniel
- Department of Radiology, Division of Interventional Radiology, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA.
| | - John M Racadio
- Department of Radiology, Division of Interventional Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Manish N Patel
- Department of Radiology, Division of Interventional Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Neil D Johnson
- Department of Radiology, Division of Interventional Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kamlesh Kukreja
- Department of Radiology, Division of Interventional Radiology, Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
8
|
Sato T, Kazama T, Fukuzawa T, Wada M, Sasaki H, Kudo H, Tanaka H, Nakamura M, Nio M. Mediastinal tumor resection via open or video-assisted surgery in 31 pediatric cases: Experiences at a single institution. J Pediatr Surg 2016; 51:530-3. [PMID: 26520698 DOI: 10.1016/j.jpedsurg.2015.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) has been increasingly used for the diagnosis and treatment of thoracic diseases. Pediatric mediastinal tumors are often difficult to resect because of their proximity to important organs. For this reason, VATS is not established as a standard surgical approach for such tumors. We compared the efficacy and safety of mediastinal tumor resection in children using open thoracotomy (OT) and VATS. METHODS A total of 31 children underwent mediastinal tumor resection (21 by VATS and 10 by OT). These nonrandomized approaches were retrospectively compared for incidence of operative complications, morbidity, and mortality. RESULTS Tumor sizes and operation times were similar between groups. However, the VATS group required significantly fewer blood transfusions and shorter durations of thoracic drainage and hospital stays (p<0.05). Complications greater than grade 2 on the Clavien-Dindo classification occurred in four patients treated by VATS and OT. No delayed effects were noted in the survivors of either group. A patient with clear cell sarcoma of the kidney who underwent OT relapsed and died. CONCLUSION Although complication rates were similar between the two approaches, VATS was suggested as less invasive because of fewer blood transfusions required, and shorter thoracic drainage and hospital stay durations.
Collapse
Affiliation(s)
- Tomoyuki Sato
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
| | - Takuro Kazama
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Taichi Fukuzawa
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Motoshi Wada
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hideyuki Sasaki
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hironori Kudo
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hiromu Tanaka
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Megumi Nakamura
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Masaki Nio
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
| |
Collapse
|
9
|
Dunn CL, McLean TW, Lucas JT, Clark H. Successful Radiofrequency Ablation for Recurrent Pulmonary Hepatoblastoma. Pediatr Blood Cancer 2015; 62:2242. [PMID: 26109368 PMCID: PMC9134866 DOI: 10.1002/pbc.25617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Charles L. Dunn
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas W. McLean
- Correspondence to: Thomas W. McLean, Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.
| | - John T. Lucas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Hollins Clark
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
10
|
Commentary on "Simultaneous Resection of High-risk Liver Tumors and Pulmonary Metastases in Children". Ann Surg 2015; 262:e4. [PMID: 26020115 DOI: 10.1097/sla.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Malkan AD, Loh AH, Fernandez-Pineda I, Sandoval JA. The Role of Thoracoscopic Surgery in Pediatric Oncology. J Laparoendosc Adv Surg Tech A 2014; 24:819-26. [DOI: 10.1089/lap.2014.0252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alpin D. Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amos H.P. Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - John A. Sandoval
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| |
Collapse
|
12
|
Peycelon M, Parmentier B, Raquillet C, Louvet N, Audry G, Auber F. [Video-assisted surgery in children: current progress and future perspectives]. Arch Pediatr 2013; 20:509-16. [PMID: 23566581 DOI: 10.1016/j.arcped.2013.02.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/01/2013] [Accepted: 02/24/2013] [Indexed: 01/10/2023]
Abstract
This review presents the evidence of video-assisted surgery in the pediatric population and discusses future progress in this field. Videosurgery minimizes the cosmetic impact and the pain induced by open procedures and has been in constant development in adults and children. Earlier training of surgeons and residents combined with advances in anesthetics and technology have expanded the use of videosurgery for more complex interventions. Although most feasible surgical procedures have been performed by laparoscopy, the literature has not yet defined it as the gold standard for most interventions, especially because of the lack of evidence for many of them. However, laparoscopy for cholecystectomy is now the preferred approach with excellent postoperative outcomes and few complications. Although no evidence has been demonstrated in children, laparoscopy has been shown to be superior in adults for gastroesophageal reflux disease and splenectomy. Laparoscopic appendectomy remains controversial. Nevertheless, meta-analyses have concluded in moderate but significant advantages in terms of pain, cosmetic considerations, and recovery for the laparoscopic approach. Laparoscopy is now adopted for undescended testes and allows both localization and surgical treatment if necessary. For benign conditions, videosurgery can be an excellent tool for nephrectomy and adrenalectomy. However, laparoscopy remains controversial in pediatric surgical oncology.
Collapse
Affiliation(s)
- M Peycelon
- Service de chirurgie viscérale pédiatrique et néonatale, hôpital Armand-Trousseau, hôpitaux universitaires Est Parisien, AP-HP, 26, avenue du Docteur-Arnold-Netter, 75012 Paris cedex 12, France.
| | | | | | | | | | | |
Collapse
|