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Bai R, Bonanni JR, Guo J, Li Z, Yu X, Zhao J, Zeng J, Garvin G, Yan Y. Opting for conservative management over surgery for neonatal ovarian cysts. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:705-716. [PMID: 38629899 DOI: 10.1002/jcu.23693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To explore the suitability of conservative management for neonatal ovarian cysts in newborns. METHODS A retrospective cohort study was conducted, involving infants diagnosed with neonatal abdominal/pelvic cysts at two separate medical institutions from January 2015 through July 2021. Data collection included clinical characteristics, imaging results, pathological findings, and postnatal outcomes. Statistical analyses were performed using the Student's t-test, Mann-Whitney U-test, and receiver operating characteristic (ROC) curve. RESULTS In total, 34 cases of neonatal abdominal/pelvic cystic masses were detected, with mean birth weight of 3401 ± 515 g. Of these, 22 patients underwent postnatal cystectomy/oophorectomy. Pathological assessments revealed 16 uncomplicated cysts, 5 complex cysts, and 1 ovarian cyst with torsion complications. Notably, the cysts' dimensions at the time of surgical intervention had significantly decreased from the initial measurements (p = 0.015). The ROC curve analysis presented an area under the curve of 0.642, indicating moderate accuracy in employing cyst size as a discriminative feature to differentiate complex from simple ovarian cysts. Additionally, a short-term follow-up of nonsurgical cases indicated a 100% resolution rate by 24 months of age (n = 9). CONCLUSION Given their predominantly benign nature, the majority of neonatal ovarian cysts seem to be amenable to conservative management. This approach remains justified for larger cysts with minimal torsion risk, as well as considering the observed reduction in cyst size at birth, which further supports the case against surgical intervention.
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Affiliation(s)
- Ruimiao Bai
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - John Ross Bonanni
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatric Radiology, Max Rady College of Medicine Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jinzhen Guo
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Xiping Yu
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Jinru Zhao
- Department of Neonatal Surgery, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, Province, China
| | - Junan Zeng
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province, China
| | - Gregory Garvin
- Department of Medical Imaging, St. Joseph's Health Care London, London, Ontario, Canada
| | - Yi Yan
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Imaging, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Radiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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Saxena AK, Mutanen A, Gorter R, Conforti A, Bagolan P, De Coppi P, Soyer T. European Paediatric Surgeons' Association Consensus Statement on the Management of Neonatal Ovarian Simple Cysts. Eur J Pediatr Surg 2024; 34:215-221. [PMID: 37557903 DOI: 10.1055/s-0043-1771211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Neonatal ovarian simple cyst management from the pediatric surgical aspect is unclear on cyst size, follow-up, and preferred surgical approach. Therefore, this topic was selected for the 2022 Consensus Session meeting of the European Paediatric Surgeons' Association (EUPSA). METHODS The literature was reviewed on a predefined set of questions relating to the management of the neonatal ovarian simple cysts by a panel of 7 EUPSA members, on current evidence-based opinion and practice outlined. Each question (1) outcomes of fetal interventions in neonates after birth and consensus on size/timing of intervention, (2) consensus on the type of interventions, and (3) complications in neonatal ovarian cysts and follow-up recommendations in nonoperated/operated cysts, was presented with available evidence to congress session participants. The management approach was agreed by participants and comments were accounted to formulate the consensus statement. RESULTS There is still limited data on potential benefits and complications of prenatal ultrasound-guided aspiration; however, neonates after such procedures should be followed for 6 months. Neonates with simple ovarian cysts larger than 4 cm should be offered surgical interventions within the 2 weeks of life with complete laparoscopic cyst aspiration and fenestration with bipolar instruments being the preferred approach. Ultrasound follow-up after surgical intervention after 3 months and with the conservative approach after every 3 to 4 months until 1 year. CONCLUSION A peer-reviewed consensus statement for the management of neonatal ovarian simple cyst was formulated based on current evidence and peer practice. The EUPSA recognizes that the statement can be useful for pediatric surgeons in decision making for this pathology.
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Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Annika Mutanen
- Department of Pediatric Surgery, University of Helsinki Children's Hospital, Helsinki, Finland
| | - Ramon Gorter
- Department of Pediatric Surgery, Emma Children's Hospital UMC, Amsterdam, the Netherlands
| | - Andrea Conforti
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Paolo De Coppi
- Department of Paediatric Surgery, UCL Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
- Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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Said H, Shafik Y, Faiz M, Bawazir O, Alhallaq O, Abdulmoez A, Al Dahshan Y. Single port laparoscopic-assisted ovarian cystectomy using optical forceps in neonates: a brief technical report. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The management of neonatal ovarian cysts is often demanding. However, offering surgery as a definitive treatment for patients who lack easy access to healthcare for follow-up is reasonable. Minimally invasive, ovary-sparing surgery provides benefits, including shorter operative times, hospital stay, and superior cosmesis. The novel modification described here renders added value because it utilizes readily available and reusable instruments, averts the need for multiple ports and large incisions, and is essentially time-saving.
So, the aim of the study is to evaluate the safety and feasibility and describe the use of optical forceps during single-port laparoscopic-assisted (SPLA) ovarian cystectomy in a specific cohort of neonates with simple/complicated ovarian cysts.
Results
Neonates who required ovarian cystectomy/salpingo-oophorectomy, admitted from January 2015 to December 2019 and fulfilled the inclusion criteria, were treated with optical forceps during SPLA. After the surgery, we put in place a follow-up protocol to monitor complications and recurrences.
Twenty-one neonates were included. The average gestational age was 37.2 ± 1.6 weeks, operative time was 43.2 ± 2.4 min, and length of hospital stay was 2.4 ± 0.5 days. In our experiment, there was no encounter with complications, recurrences, or ones that required conversion to laparotomy, nor did we require the use of extra ports.
Conclusion
SPLA procedures using optical forceps for managing neonatal cysts requiring surgery appear to be a safe and achievable option by allowing complete visualization of the cyst/lesion. It also has an excellent cosmetic result with a near-normal umbilicus scar. Further research is required to compare this method to open and laparoscopic standards.
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Abstract
BACKGROUND Because of the restricted space of the peritoneal cavity and the easy mobility of abdominal and pelvic organs in infants and neonates, the boundary of minimally invasive surgery was extended to complete the operation outside the abdomen. The objective of this study was to report our experience with transumbilical laparoscopic-assisted surgery (TULS) in different abdominal pathologies in infants and neonates. PATIENTS AND METHODS A retrospective study was conducted on 59 patients who underwent TULS from 2014 to 2020. The study outcomes were the conversion to open approach, length of hospital stay and post-operative complications. RESULTS The most common indications were explorations for intra-abdominal testes (n = 15) and inguinal herniorrhaphy (n = 13). Patients who had surgery for pyloric stenosis were younger (1.03 ± 0.25 months). The average operative time was 45.9 ± 18.39 min. The longest operative time was reported with surgery for liver cysts (94.5 ± 10.6 min). Oral intake was started after 48-56 h in patients who had excision of duplication cysts. The average post-operative hospital stay was 2.6 ± 1.52 days. No major complications were reported. Wound infection occurred in one patient with a duplication cyst. Three patients were converted to open repair (5.1%) and no late complications were reported during the mean follow-up time of 11.2 ± 5.1 months. CONCLUSIONS The transumbilical approach is a safe alternative method to laparotomy in several abdominal pathologies in infants and neonates. It has a short operative time and hospital stay. The technique is associated with few complications and conversion rates.
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Affiliation(s)
- Osama Abdullah Bawazir
- Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah; Department of Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, KSA
| | - Razan Bawazir
- Medical Student, Medical College, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, KSA
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Chiarenza SF, Conighi ML, Conforti A, Bleve C, Esposito C, Escolino M, Beretta F, Cheli M, Di Benedetto V, Scuderi MG, Casadio G, Marzaro M, Gambino M, Pini Prato A, Molinaro F, Gerocarni Nappo S, Caione P. Guidelines of the Italian Society of Videosurgery in Infancy (SIVI) for the minimally invasive treatment of fetal and neonatal ovarian cysts. LA PEDIATRIA MEDICA E CHIRURGICA 2020; 42. [PMID: 33140631 DOI: 10.4081/pmc.2020.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
In the last three decades, fetal ovarian cysts were diagnosed more frequently, due to technological improvement and the increasing use of prenatal screening ultrasound. Nonetheless, treatment uncertainties are still present, either prenatally or postnatally. Recently, significant innovations on diagnosis and treatment have been proposed and a more conservative, minimally invasive approach may be offered to the Pediatrician or the Surgeon who face with this condition during prenatal or neonatal age. (...).
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Affiliation(s)
- Salvatore Fabio Chiarenza
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Maria Luisa Conighi
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Andrea Conforti
- Congenital Esophageal Disorders Unit, Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital, Rome.
| | - Cosimo Bleve
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II University, Naples.
| | | | | | - Maurizio Cheli
- Pediatric Surgery Department Papa Giovanni XXIII Hospital, Bergamo.
| | | | | | | | - Maurizio Marzaro
- Pediatric Surgery Unit, Local Health Unit 2, Treviso Hospital, Treviso.
| | - Marco Gambino
- Pediatric Surgery Unit, Annunziata Civil Hospital, Cosenza.
| | - Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | - Francesco Molinaro
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena.
| | | | - Paolo Caione
- Pediatric Surgery and Urologic Unit, Pediatric Hospital Bambino Gesù, Rome.
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Approaches to the management of pediatric ovarian masses in the 21st century: Systematic review and meta-analysis. J Pediatr Surg 2020; 55:357-368. [PMID: 31706611 DOI: 10.1016/j.jpedsurg.2019.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 07/24/2019] [Accepted: 09/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopy is increasingly being adopted for the treatment of ovarian pathologies in adults. However, its implementation for the management of pediatric ovarian masses varies and the evidence, to date, has not been comprehensively analyzed. This review aims to compare laparoscopic and open surgical management of pediatric ovarian masses. METHODS We searched PubMed, Cochrane Library and Google Scholar from the year 2000 till April 2017. Studies selected for this included those on epidemiological trends of pediatric ovarian lesions, assessing outcomes of laparoscopic management and comparison of laparoscopic and open surgical techniques for pediatric ovarian masses. A meta-analysis comparing outcomes of both modalities was performed using standard methodology. RESULTS A total of 44 studies met the inclusion criteria of which 15 were on histological types of ovarian lesions, 24 assessed laparoscopic management only and five compared laparoscopy with open surgery for pediatric ovarian masses. Nonneoplastic lesions were the most common ranging from 36.5% to 73.7%, with cystic lesions being the most prevalent. Neoplastic lesions ranged between 26.3% and 63.5%, with germ cell tumors being the most common, while malignancy ranged between 3.5% and 10.8%. Laparoscopic management was generally advocated for managing benign lesions with a cautious approach for suspicion of malignant lesions. In comparison to open surgery, laparoscopic surgery had shorter operating time (MD = -33.24 min, 95% CI = -34.29 to -32.19, p < 0.0001), less intraop bleeding (MD = - 61.46 ml, 95% CI = -62.69 to -60.24, p < 0.0001), and reduced length of hospital stay (MD = -2.78 days, 95% CI= -2.82 to -2.74, p<0.0001). Complication rates were equivocal between the two approaches. Spillage rates could not be assessed. CONCLUSION Limited evidence suggests that laparoscopic approach to presumptively benign ovarian masses have better outcomes when compared to open surgery with regards to operating time, blood loss and hospital stay. However, complication rates were similar between the two approaches. Studies with rigorous scientific methods are needed for a definitive recommendation, especially in resource limiting settings. However malignant lesions should still be managed with an open surgical approach to avoid upstaging of disease status. LEVEL OF EVIDENCE II.
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Laparoscopic Excision of Large Intra-Abdominal Cysts in Children: Needle Hitch Technique. Case Rep Med 2016; 2015:937191. [PMID: 26798349 PMCID: PMC4698560 DOI: 10.1155/2015/937191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/08/2015] [Indexed: 01/22/2023] Open
Abstract
Laparoscopic surgery has both diagnostic and therapeutic advantages in the management of intra-abdominal cysts in children. Large cysts in small children pose technical challenges during laparoscopic surgery, requiring multiple incisions and advanced laparoscopic skills. This paper describes a novel laparoscopic technique using minimal manipulation for both aspiration and excision of the cyst. This simple, safe, and effective approach was used to achieve traction and facilitate excision of a large intra-abdominal cyst in a neonate and a young child.
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Kozlov Y, Novozhilov V, Baradieva P, Krasnov P, Kovalkov K, Muensterer OJ. Single-incision pediatric endosurgery in newborns and infants. World J Clin Pediatr 2015; 4:55-65. [PMID: 26566478 PMCID: PMC4637810 DOI: 10.5409/wjcp.v4.i4.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/22/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
This study focuses on the successful application of single-incision pediatric endosurgery in the treatment of congenital anomalies and acquired diseases in neonates and infants. The purpose of this scientific review consists in highlighting the spectrum, indications, applicability, and effectiveness of single-port endosurgery in children during the first 3 postnatal months.
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9
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Single-Incision Single-Instrument Adnexal Surgery in Pediatric Patients. Minim Invasive Surg 2015; 2015:246950. [PMID: 26557994 PMCID: PMC4617692 DOI: 10.1155/2015/246950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 01/30/2023] Open
Abstract
Introduction. Pediatric surgeons often practice pediatric gynecology. The single-incision single-instrument (SISI) technique used for appendectomy is applicable in gynecologic surgery. Methods. We retrospectively analyzed the records of patients undergoing pelvic surgery from 2008 to 2013. SISI utilized a 12 mm transumbilical trocar and an operating endoscope. The adnexa can be detorsed intracorporeally or extracorporealized via the umbilicus for lesion removal. Results. We performed 271 ovarian or paraovarian surgeries in 258 patients. In 147 (54%), the initial approach was SISI; 75 cases (51%) were completed in patients aged from 1 day to 19.9 years and weighing 4.7 to 117 kg. Conversion to standard laparoscopy was due to contralateral oophoropexy, solid mass, inability to mobilize the adnexa, large mass, bleeding, adhesions, or better visualization. When SISI surgery was converted to Pfannenstiel, the principal reason was a solid mass. SISI surgery was significantly shorter than standard laparoscopy. There were no major complications and the overall cohort had an 11% minor complication rate. Conclusion. SISI adnexal surgery is safe, quick, inexpensive, and effective in pediatric patients. SISI was successful in over half the patients in whom it was attempted and offers a scarless result. If unsuccessful, the majority of cases can be completed with standard multiport laparoscopy.
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Ovarian Cyst Aspiration in the Neonate: Minimally Invasive Surgery. J Pediatr Adolesc Gynecol 2015; 28:348-53. [PMID: 26148782 DOI: 10.1016/j.jpag.2014.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/04/2014] [Accepted: 10/07/2014] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To review our experience with laparoscopic aspirations and minimally invasive surgeries for neonatal ovarian cysts and report the outcome of their follow-up. DESIGN Twenty-one neonates diagnosed as having ovarian cysts were retrospectively reviewed at our hospital from 2006 through 2013. RESULTS Of 21 neonates, 8 showed simple cysts and 13 showed complex cysts in their ultrasound scan. Laparoscopic aspiration was performed for all neonates with simple cysts. Torsion was found in 7 of 13 neonates with complex cysts. Three neonates underwent detorsion, while 2 neonates underwent oophorectomy. Two neonates already showed autoligation, showing a cystic mass, which was removed. The remaining 6 neonates with a complex cyst underwent only aspiration because no torsion was found. Of 14 neonates who underwent only aspiration, 11 showed no cyst, while 3 neonates, having a cyst with a size of less than 2 cm, underwent follow-up. Of 3 neonates who underwent detorsion, 1 showed an ovary without cyst, while 2 showed neither cyst nor ovary. CONCLUSION Laparoscopically, neonatal ovarian cysts may be diagnosed and aspirated simultaneously, simply, and safely.
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Antonakopoulos N, Agrapidis D, Karras G, Stefanidis K, Loutradis D. Torted large prenatally detected foetal ovarian cyst. J OBSTET GYNAECOL 2015; 35:848-9. [PMID: 25671519 DOI: 10.3109/01443615.2015.1009877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Antonakopoulos
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - D Agrapidis
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - G Karras
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - K Stefanidis
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - D Loutradis
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
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Parelkar SV, Oak SN, Bachani MK, Sanghvi BV, Gupta R, Prakash A, Patil R, Sahoo S. Minimal access surgery in newborns and small infants; five years experience. J Minim Access Surg 2013; 9:19-24. [PMID: 23626415 PMCID: PMC3630711 DOI: 10.4103/0972-9941.107129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 03/02/2012] [Indexed: 11/21/2022] Open
Abstract
AIMS AND OBJECTIVES: The aim of this study was to assess and present the outcome (initial experience and lessons learnt) of minimally invasive surgery for various indications in neonates and small infants (< 5 kg) at a single medical centre. MATERIALS AND METHODS: A retrospective analysis was performed on 65 patients (age day 2 to 10 months) managed with minimal access surgery (MAS) for various indications, between 2005 and 2010. We analyzed demographic information, procedures, complications, outcomes, and follow-up and overall feasibility of the procedure. RESULTS: No serious complications except one death in congenital diaphragmatic hernia (CDH) (due to other comorbidities) occurred. Intra operative hypercarbia and hypoxia were observed more frequently in thoracoscopic procedures. Intra operative hypothermia was not common and was well tolerated. Conversion to open procedure (n = 5), post operative ileus (n = 3), port site infection (n = 5) were other complications. CONCLUSION: MAS in neonates and small infants is a technically demanding but a feasible choice available. Some prior experience in older children is required for safe and effective outcome. Good quality optics, video equipments and instruments are required for safe and effective procedure. Intra operative measurement of oxygen saturation and temperature, and diligent post operative ICU care are mandatory for safe and successful outcome.
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Affiliation(s)
- Sandesh V Parelkar
- Department of Pediatric Surgery, KEM Hospital and Seth G S Medical College, Parel, Mumbai, Maharashtra, India
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Saldaña LJ, Targarona EM. Single-incision pediatric endosurgery: a systematic review. J Laparoendosc Adv Surg Tech A 2013; 23:467-80. [PMID: 23560658 DOI: 10.1089/lap.2012.0467] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Single-incision pediatric endosurgery (SIPES) is defined as minimally invasive surgery performed through a unique incision in the abdomen, chest, or retroperitoneum. Several publications exist, but no previous systematic review has been made to evaluate the real benefits of this approach in terms of feasibility and clinical outcomes. MATERIALS AND METHODS We performed an electronic search in PubMed up to March 2012 with the terms "single AND incision OR site OR port OR trocar AND children" including related articles and obtained 197 articles. After applying our inclusion criteria, 78 articles were reviewed. RESULTS We identified prospective controlled trials (n=1), case-control studies (n=12), case series (n=49), and case reports (n=16). In total, 4212 patients had been operated on by SIPES and were separated by systems: gastrointestinal (n=2888), urologic (n=390), gynecologic (n=27), other abdominal (n=874), and thoracic (n=33) procedures. The most common procedure was SIPES appendectomy, and a unique prospective controlled trial supports its safety and effectiveness. Technically demanding surgeries such as hepatojejunostomy and colonic surgeries were described. Multichannel ports and multiple ports, standard and articulated instruments, transparietal instruments, retraction sutures, and magnets were used. Operative times, length of stay, and complications similar to standard laparoscopic surgery were described. A low conversion rate (to a reduced port, standard laparoscopy and open procedures) was also mentioned. No comparable measure for pain and cosmesis assessment was used. CONCLUSIONS A wide experience in SIPES and feasibility has already been described with good clinical outcomes and low rate of conversion. Appendectomy is the unique procedure in which SIPES has been demonstrated to be safe and effective. It is pending the execution of prospective controlled trials for other operations to demonstrate, with objective evidence, the real benefits of this less invasive approach.
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Affiliation(s)
- Lily J Saldaña
- Department of Pediatric Surgery, Institute of Child Health, Lima, Peru.
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Akkoyun I, Gülen S. Laparoscopic cystectomy for the treatment of benign ovarian cysts in children: an analysis of 21 cases. J Pediatr Adolesc Gynecol 2012; 25:364-6. [PMID: 22995767 DOI: 10.1016/j.jpag.2012.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 06/08/2012] [Accepted: 06/13/2012] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To evaluate the outcomes of treatment with minimal invasive surgery in children with benign ovarian cysts. DESIGN Retrospective chart review. SETTINGS Maternity and children hospital. PATIENTS Between May 2007 and May 2011, 21 children were treated by laparoscopic method for ovarian cysts at our clinic. The age, symptoms, ultrasonographic findings, operation records and follow-up times were retrospectively evaluated. RESULTS The mean age was 13.2 years. One patient presented with findings of torsion and another presented with findings of rupture; both were urgently operated on. The other patients presented with intermittent abdominal pain and were operated on under elective basis. The mean cyst size was 8.4 cm (5-13 cm). One patient with necrotic ovary and salpinx due to torsion underwent salpingo-oophorectomy while the others were administered ovary-preserving cystectomy. Only 4 patients required iv paracetamol as an analgesic in the postoperative period. Two patients were discharged on the second postoperative day while the remaining 19 patients were discharged on the first postoperative day. During a mean follow-up of 14 months, no recurrence was seen in this period. Cosmetic appearance was good in all patients. CONCLUSION The authors demonstrated that laparoscopic cystectomy was a technically feasible and safe method in the treatment of benign ovarian cysts, associated with short hospitalization, minimal analgesic requirement, and a good cosmetic appearance.
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Affiliation(s)
- Ibrahim Akkoyun
- Department of Pediatric Surgery, Dr. Faruk Sükan Maternity and Children's Hospital, Konya, Turkey.
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Isobaric Laparoendoscopic Single-Site Assisted Extracorporeal Cystectomy in Treatment of Selected Adnexal Tumors: Initial Experience and Technique. J Minim Invasive Gynecol 2010; 17:766-70. [DOI: 10.1016/j.jmig.2010.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 07/14/2010] [Accepted: 07/22/2010] [Indexed: 11/22/2022]
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Ahmed K, Wang TT, Patel VM, Nagpal K, Clark J, Ali M, Deeba S, Ashrafian H, Darzi A, Athanasiou T, Paraskeva P. The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc 2010; 25:378-96. [PMID: 20623239 DOI: 10.1007/s00464-010-1208-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 04/09/2010] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This review aimed to determine the role of single-incision laparoscopic surgery (SILS) in abdominal and pelvic operations. DATA SOURCES The Medline, EMBASE, and PsycINFO databases were systematically searched until October 2009 using "single-incision laparoscopic surgery" and related terms as keywords. References from retrieved articles were reviewed to broaden the search STUDY SELECTION The study included case reports, case series, and empirical studies that reported SILS in abdominal and pelvic operations. DATA EXTRACTION Number of patients, type of instruments, operative time, blood loss, conversion rate, length of hospital stay, length of follow-up evaluation, and complications were extracted from the reviewed items DATA SYNTHESIS The review included 102 studies classified as level 4 evidence. Most of these studies investigated SILS in cholecystectomy (n=34), appendectomy (n=24), and nephrectomy (n=17). For these procedures, operative time, hospital stay, and complications were comparable with those of conventional laparoscopy. Conversion to conventional laparoscopy was seldom performed in cholecystectomy (range, 0-24%) and more frequent in appendectomy (range, 0-41%) and nephrectomy (range, 0-33%). CONCLUSION The potential benefits of SILS include superior cosmesis and possibly shorter operative time, lower costs, and a shortened time to full physical recovery. Careful case selection and a low threshold of conversion to conventional laparoscopic surgery are essential. Multicenter, randomized, prospective studies are needed to compare short- and long-term outcome measures against those of conventional laparoscopic surgery.
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Affiliation(s)
- Kamran Ahmed
- Department of Biosurgery and Surgical Technology, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, Praed Street, London, W2 1NY, UK.
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17
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Kim WC, Kwon YS. Laparoendoscopic single-site surgery for exteriorization and cystectomy of an ovarian tumor during pregnancy. J Minim Invasive Gynecol 2010; 17:386-9. [PMID: 20417433 DOI: 10.1016/j.jmig.2009.12.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 12/28/2009] [Accepted: 12/31/2009] [Indexed: 11/17/2022]
Abstract
Herein, we describe a surgical approach for management of a pregnant woman with an ovarian tumor using laparoendoscopic single-site surgery with exteriorization. We assessed both the feasibility and cosmetic outcome. The operation lasted 25 minutes, and the estimated blood loss was negligible. No perioperative or postoperative complications developed, and the patient was discharged on postoperative day 2.
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Affiliation(s)
- Woo-Chul Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
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18
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Abstract
Videoscopic surgery has become the standard approach for most thoracic, abdominal, and pelvic procedures in adults and children. These procedures have widely recognized benefits including decreased postoperative pain, improved cosmesis, and decreased convalescence. In a recent attempt to further improve the cosmetic result of these operations, surgeons have begun to employ a single incision through which all the operating instruments are placed. This article seeks to review the current and future application of innovative minimally invasive surgery to pediatric surgery.
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Michelotti B, Segura BJ, Sau I, Perez-Bertolez S, Prince JM, Kane TD. Surgical Management of Ovarian Disease in Infants, Children, and Adolescents: A 15-Year Review. J Laparoendosc Adv Surg Tech A 2010; 20:261-4. [DOI: 10.1089/lap.2009.0137] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brett Michelotti
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bradley J. Segura
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Indranil Sau
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sonia Perez-Bertolez
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jose M. Prince
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Timothy D. Kane
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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20
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Top technology issues for ambulatory care facilities this year and beyond. J Ambul Care Manage 2010; 32:303-19. [PMID: 19888007 DOI: 10.1097/jac.0b013e3181ba6f86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ECRI Institute medical technology experts (i.e., biomedical engineers, patient safety experts, physicians, and research scientists) compiled a list of important technology-related issues that executives and clinical leaders at ambulatory care facilities should pay close attention to this year. The list presents several high-profile technologies in the context of the convergence of critical economic, patient safety, reimbursement, and regulatory pressures. Guidance is provided about key considerations regarding adoption and implementation of electronic medical records, high-end computed tomography and magnetic resonance imaging technology, the convergence of health information technology and medical technologies highlighting integrated patient alarm systems as a case in point, physician preference items such as cardiac stents, robotic-assisted technology for minimally invasive procedures, image-guided radiation technologies, and the role of radiofrequency identification technology.
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