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McElhinney KL, Zeineddin S, Ahle SL, Goldstein SD, Lautz TB. Intercostal nerve cryoablation reduces opioid utilization after thoracotomy in children with cancer. Pediatr Blood Cancer 2024; 71:e30722. [PMID: 37843290 PMCID: PMC10841358 DOI: 10.1002/pbc.30722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/10/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Intercostal nerve cryoablation (INC) has shown promise as an adjunct method for analgesia in adults undergoing thoracotomy, but has yet to be widely used in children for this indication. We hypothesize that INC decreases opioid utilization in children undergoing thoracotomy for cancer operations. METHODS A retrospective review was performed of children who underwent thoracotomy for cancer diagnosis at a freestanding children's hospital from 2018 to 2023. Patient characteristics, intraoperative data, and data on clinical course were collected. Patients were divided into those who underwent INC and those who underwent routine care for comparison. RESULTS Twenty-six patients underwent 38 procedures at a median age of 16 years (range 5-21 years). INC was performed in 23 cases over a median of five intercostal levels (range 2-7). Total oral morphine equivalents during inpatient admission were significantly lower in INC patients (137.6 vs. 514.5 mg, p = .002). Routine care patients were more likely to be discharged with an opioid prescription (30.4% vs. 80.0%, p = .008). Length of stay was similar between patients with INC and routine care (4 vs. 5 days, p = .15). There were no differences in rates of reoperation or 30-day re-admission (emergency department or inpatient). CONCLUSTIONS INC is a feasible and safe adjunct for children undergoing thoracotomy for cancer. INC is associated with reduced postoperative opioid utilization with respect to both inpatient use and outpatient prescriptions.
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Affiliation(s)
- Kathryn L McElhinney
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Suhail Zeineddin
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Samantha L Ahle
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Seth D Goldstein
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Svetanoff WJ, Bergus KC, Xia J, Diefenbach KA, Michalsky MP, Aldrink JH. Robotic-assisted resection of mediastinal tumors in pediatric patients. Semin Pediatr Surg 2023; 32:151262. [PMID: 36738480 DOI: 10.1016/j.sempedsurg.2023.151262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Wendy Jo Svetanoff
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States
| | - Katherine C Bergus
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States; Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jason Xia
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States
| | - Karen A Diefenbach
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States; Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Marc P Michalsky
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States; Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States; Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, United States.
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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.
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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
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Chen C, Zhang X, Gu C, Wang Y, Liu K, Pan X, Fu S, Fan L, Wang R. Surgery performed at night by continuously working surgeons contributes to a higher incidence of intraoperative complications in video-assisted thoracoscopic pulmonary resection: a large monocentric retrospective study. Eur J Cardiothorac Surg 2021; 57:447-454. [PMID: 31539044 DOI: 10.1093/ejcts/ezz253] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our goal was to assess the influence of working hours and working at night on intraoperative complications on surgeons conducting video-assisted pulmonary resections. METHODS We identified all patients who underwent video-assisted thoracoscopic surgery (VATS) in Shanghai Chest Hospital from January 2015 to April 2017. Univariable and multivariable logistic analyses were used to analyse independent risk factors for intraoperative complications. A 1:4 propensity score matching analysis was conducted to verify those results. RESULTS A total of 15 767 patients who underwent VATS pulmonary resection were included in this study. Among them, 15 280 patients (96.1%) were operated on during daytime working hours and 487 (3.1%) at night. A total of 203 (1.3%) intraoperative complications occurred. Vascular injury was the main cause of intraoperative complications, accounting for 92.1% (187/203). Multivariable logistic regression indicated that age [odds ratio (OR) = 1.68, 95% confidence interval (CI) 1.43-1.98; P < 0.001], gender (OR = 1.71, 95% CI 1.26-2.32; P = 0.001), surgical experience (OR = 2.07, 95% CI 1.56-2.75; P < 0.001), type of surgery (OR = 0.31, 95% CI 0.20-0.49; P < 0.001) and operative periods (OR = 2.69, 95% CI 1.61-4.86; P < 0.001) were independent predictors for intraoperative complications. The incidence of intraoperative complications during night-time surgery was significantly higher than that during daytime working hours. A 1:4 propensity score matching-based results verification showed that night-time surgery was still an independent risk factor after propensity score matching (OR = 2.76, 95% CI 1.47-5.15; P = 0.002). CONCLUSIONS The incidence of intraoperative complications from VATS pulmonary resection performed during night hours was significantly higher than that performed during working hours. In the present labour environment, thoracic surgeons should avoid night-time surgery whenever possible.
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Affiliation(s)
- Chunji Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaofeng Zhang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai Tongji University, Shanghai, China
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kun Liu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shijie Fu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Limin Fan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Riccipetitoni G, Bertozzi M, Gazzaneo M, Raffaele A, Vatta F. The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature. Front Pediatr 2021; 9:721914. [PMID: 34712630 PMCID: PMC8546295 DOI: 10.3389/fped.2021.721914] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 01/25/2023] Open
Abstract
Aim: Video-assisted thoracoscopic surgery (VATS) has been widely used in the last decades. Nevertheless, the pros and cons of thoracoscopy vs. open surgery in pediatric oncology are still under debate. In literature, VATS has been applied for both diagnostic and ablative surgery to treat neurogenic tumors, thymic neoplasms, lung tumors and metastases, germ cell tumors, lymphoproliferative diseases, and other rare tumors. Recent reviews described excellent outcomes in pediatric oncology as well as in the treatment of adult lung cancer, with a significantly higher rate of mortality and complication in thoracotomy compared to VATS. We reviewed our experience on thoracoscopy in pediatric malignancy and compared it to the literature. Materials and Methods: This was a retrospective cohort-study of pediatric oncological patients who underwent VATS at our institution from 2007 to 2020, and a review of the recent literature on the topic. Results: A total of 43 procedures were performed on 38 oncological patients (18 males, 20 females). Median age was years 7.72 (0.35-18.6). Diagnosis: 10 neurogenic tumors, nine hematological diseases, five metastases, four lypoblastomas, three thymic pathologies, three germ cell tumors, two pleuropneumoblastomas, two myofibroblastic tumors, one myoepithelial carcinoma, one liposarcoma, and three suspected oncological mass. In three cases, a 3D model was elaborated to better plan the surgical approach. Diagnostic biopsies were 22 (51.1%), and ablative surgeries, 21 (48.9%). One neurogenic tumor was resected with the Da Vinci Robot. Median operative time was 120 min (30-420). A drain was left in place in 20 (46.5%) for a median of 4 days. Median length of hospitalization was 5 days (1-18). One case (2.3%) was converted (intraoperative bleeding). There were three post-operative complications (7.0%): one pneumonia, one pleural effusion, and one diaphragmatic paralysis (need for plication). Results were compared to recent literature, and morbidity and conversion rate were comparable to reviewed publications. Conclusion: VATS represents a valuable tool for diagnostic and therapeutic procedures in pediatric oncology. Nonetheless, it is a challenging technique that should be performed by expert surgeons on oncological and mini-invasive surgery. Three-dimensional reconstruction can optimize the pre-operative planning and guarantee a safer and more targeted treatment. Finally, the advent of robotics-assisted surgery represents a new challenge that may further implement the advantages of VATS.
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Affiliation(s)
- Giovanna Riccipetitoni
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mirko Bertozzi
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Marta Gazzaneo
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandro Raffaele
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fabrizio Vatta
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
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Navarrete-Arellano M. Thoracic surgery by minimally invasion robot-assisted in children: “experience and current status”. MINI-INVASIVE SURGERY 2020. [DOI: 10.20517/2574-1225.2019.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aim: We report our experience in minimally invasive thoracic robot-assisted surgery in children, and a current analysis is carried out on this topic.
Methods: Observational, prospective, and longitudinal studies were performed for children with thoracic pathology treated with robotic surgery, from March 2015 to April 2019. We used the “da Vinci surgical system” (Intuitive Surgical, Inc., Sunnyvale, CA. USA). Registered variables included demographic data, diagnosis, surgery, total time, time of console surgery, bleeding, hemotransfusions, conversions, complications, postoperative (PO) stay, and follow-up. Measures of central tendency were used. Research Ethics Committee of Hospital approved the study. We conducted a detailed non-systematic review of previous publications of children undergoing thoracic robotic surgery.
Results: We treated 11 children, with average age of 5.7 years and weight of 21.3 kg. Diagnosis were: congenital cystic adenomatoid malformation, intralobar sequestration, diaphragmatic paralysis, diaphragmatic eventration, mediastinal teratoma, Ewing’s tumor of the fourth left rib, and pulmonary tuberculosis. Surgeries performed were: four lobectomies, four diaphragmatic plications, two tumor resections, and a case of pleural and lung biopsies. The average of console surgery time was 166.45 min, PO stay was 3.6 days, and follow-up was 24.7 months. Conversions and PO complications were 9.1%, and there were no intraoperative complications and mortality. Currently, the number of children treated with thoracic robot-assisted surgery has barely reached 100 cases.
Conclusion: Our results are encouraging, although our experience is limited to a few cases. Robotic surgery for the treatment of thoracic pathology is feasible and safe, and has advantages. To date, very few patients have been treated, and few pediatric surgeons worldwide have applied thoracic robotic surgery in children.
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Pham LH, Trinh DK, Nguyen AV, Nguyen LS, Le DT, Nguyen DH, Doan HQ, Nguyen UH. Thoracoscopic surgery approach to mediastinal mature teratomas: a single-center experience. J Cardiothorac Surg 2020; 15:35. [PMID: 32051013 PMCID: PMC7017456 DOI: 10.1186/s13019-020-1076-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/30/2020] [Indexed: 11/26/2022] Open
Abstract
Background Mediastinal mature teratomas are rare tumors with diverse surgical approaches. The aim of this study is to review our experience of thoracoscopic surgery management in patients with teratomas. Methods We retrospectively reviewed 28 consecutive patients with mediastinal mature teratomas who underwent thoracoscopic surgery at Viet Duc University Hospital from January 2008 to August2018. Patients were divided into 2 groups with 2 types of thoracoscopic surgery, closed thoracoscopic surgery (CTS) group and video-assisted thoracoscopic surgery (VATS) group. The selection of sugical approach was based on sizes, locations and characteristics of tumors. Post-operative outcomes were assessed and compared between these 2 groups. Results There were 14 female and 14 male patients with a median age of 41.2 ± 13.8 years. A total of 22 teratomas were located on the right side of the chest cavity and 6 on the left side. We performed CTS in 21 patients (75%) and VATS in 7 patients (25%) for tumor resection. There were 3 cases (10.7%) required conversion to minithoracotomy (5 cm in incision length). Skin appendages accounted for the highest rate (96.4%) in pathology. There was no record of mortality or tumor recurrence detected by computerized tomography. Conclusion A thoracoscopic surgery for a mediastinal mature teratoma was a feasible choice. Challenging factors such as large tumors, intraoperative bleeding and strong tumor cell adhesion were considered handling by conversion to mini-thoracotomy that could ensure safety procedures and complete removal of tumors. Extraction of tumor contents might be performed for patients with large mature cystic teratomas to facilitate thoracoscopic surgery.
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Affiliation(s)
- Lu Huu Pham
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Hanoi, 100000, Vietnam.,Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Diep Ke Trinh
- Department of Anesthesia, Viet Duc University Hospital, Hanoi, 100000, Vietnam
| | - Anh Viet Nguyen
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Hanoi, 100000, Vietnam
| | - Lanh Sy Nguyen
- Department of Pathology, Viet Duc University Hospital, Hanoi, 100000, Vietnam
| | - Dung Thanh Le
- Department of Radiology, Viet Duc University Hospital, Hanoi, 100000, Vietnam
| | - Dinh-Hoa Nguyen
- Department of Trauma and Orthopaedic Surgery, Viet Duc University Hospital, Hanoi, 100000, Vietnam.
| | - Hung Quoc Doan
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Hanoi, 100000, Vietnam.,Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Uoc Huu Nguyen
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Hanoi, 100000, Vietnam.,Hanoi Medical University, Hanoi, 100000, Vietnam
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