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Pio L, Tulelli B, Ali L, Carvalho L, Chalhoub M, Julien-Marsollier F, Bonnard A. Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1881. [PMID: 38136083 PMCID: PMC10742299 DOI: 10.3390/children10121881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Same-day discharge after a cholecystectomy is a common practice in the adult population and has been demonstrated as safe and viable for children as well. However, there is a lack of comprehensive teaching models for pediatric cholecystectomy. Drawing inspiration from standardized outpatient procedures, this study aimed to assess the clinical outcomes and feasibility of teaching programs and an Enhanced Recovery After Surgery (ERAS) protocol following ambulatory laparoscopic cholecystectomy in pediatric patients. METHODS In 2015, an ERAS pathway for laparoscopic cholecystectomy (LC) was implemented, focusing on admission procedures, surgery timing, anesthetic choices, analgesia, postoperative feeding, mobilization, and pain assessment. Day-case surgery was not applicable for acute cholecystitis, choledochal lithiasis, sickle cell disease, and hereditary spherocytosis cases. The protocol was employed for a group of attending surgeons and fellows, as well as a group of residents under the supervision of experienced surgeons. A retrospective analysis was conducted to evaluate the feasibility and effectiveness of ambulatory cholecystectomy in children and its utilization in training pediatric surgical trainees. RESULTS Between 2015 and 2020, a total of 33 patients were included from a cohort of 162 children who underwent LC, with 15 children operated on by senior surgeons and 18 by young surgeons. The primary diagnoses were symptomatic gallbladder lithiasis (n = 32) and biliary dyskinesia (n = 1). The median age at the time of surgery was 11.3 years (interquartile range (IQR) 4.9-18), and the median duration of surgery was 54 min (IQR 13-145). One intraoperative complication occurred, involving gallbladder rupture and the dissemination of lithiasis into the peritoneal cavity. Three patients (9%) required an overnight stay, while no postoperative complications or readmissions within 30 days were observed. ERAS was successfully implemented in 30 patients (91%). No significant differences in surgical outcomes were noted between senior and young surgeons. At an average follow-up of 55 months, no long-term sequelae were identified. CONCLUSIONS These findings align with the current trend of increasing use of outpatient laparoscopic cholecystectomy and underscore its feasibility in the pediatric population. The application of a structured ERAS protocol appears viable and practical for training the next generation of pediatric surgeons. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Luca Pio
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
- Paediatric Surgery Department, University Sorbonne Paris-Cité, 75006 Paris, France
| | - Berenice Tulelli
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Liza Ali
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Lucas Carvalho
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Marc Chalhoub
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Florence Julien-Marsollier
- Department of Anesthesia, Intensive Care and Pain Management, Robert Debré Children University Hospital, APHP, 75019 Paris, France;
| | - Arnaud Bonnard
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
- Paediatric Surgery Department, University Sorbonne Paris-Cité, 75006 Paris, France
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Ferreira J, Patel P, Guadagno E, Ow N, Wray J, Emil S, Poenaru D. Patient experience or patient satisfaction? A systematic review of child- and family-reported experience measures in pediatric surgery. J Pediatr Surg 2023; 58:862-870. [PMID: 36797113 DOI: 10.1016/j.jpedsurg.2023.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly recognized as important health care quality indicators. PREMs measure patients' perception of the care they have received, differing from satisfaction ratings, which measure their expectations. The use of PREMs in pediatric surgery is limited, prompting this systematic review to assess their characteristics and identify areas for improvement. METHODS A search was conducted in eight databases from inception until January 12, 2022, to identify PREMs used with pediatric surgical patients, with no language restrictions. We focused on studies of patient experience but also included studies that assessed satisfaction and sampled experience domains. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool. RESULTS Following title and abstract screening of 2633 studies, 51 were included for full-text review, of which 22 were subsequently excluded because they measured only patient satisfaction rather than experience, and 14 were excluded for a range of other reasons. Out of the 15 included studies, questionnaires used in 12 studies were proxy-reported by parents and in 3 by both parents and children; none focused only on the child. Most instruments were developed in-house for each specific study, without patients' involvement in the process, and were not validated. CONCLUSIONS Although PROMs are increasingly used in pediatric surgery, PREMs are not yet in use, being typically substituted by satisfaction surveys. Significant efforts are needed to develop and implement PREMs in pediatric surgical care, in order to effectively capture children's and families' voices. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Julia Ferreira
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Prachikumari Patel
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Nikki Ow
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jo Wray
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sherif Emil
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Dan Poenaru
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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Ferrero PA, Blanc T, Binet A, Arnaud A, Abbo O, Vatta F, Bonnard A, Spampinato G, Lardy H, Fourcade L, Ballouhey Q. The Potential and the Limitations of Esophageal Robotic Surgery in Children. Eur J Pediatr Surg 2022; 32:170-176. [PMID: 33378777 DOI: 10.1055/s-0040-1721770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There have been numerous reports of robotic pediatric surgery in the literature, particularly regarding urological procedures for school-aged children. Thoracic procedures appear to be less common, despite the fact that encouraging results were reported more than 10 years. Our aim was to report a national experience of esophageal robotic-assisted thoracoscopic surgery (ERATS) and to discuss the most appropriate indications. MATERIALS AND METHODS A retrospective multicenter study was conducted to compile the ERATS performed at five French surgical centers that have been involved in spearheading robotic pediatric surgery over the past 15 years. The data were supplemented by a review of the literature. RESULTS Over the study period, 68 cases of robotic thoracic surgery were performed at the five pediatric centers in question. ERATS was performed for 18 patients (mean age 7.1 years [ ± 5.6]) in four of the centers. These comprised seven esophageal duplications, four esophageal atresias, five Heller's myotomies, and two cases of esophagoplasty. A conversion was needed for two neonates (11%) due to exposure difficulties. Four other procedures for patients who weighed less than 15 kg were successfully completed without causing postoperative complications. In the past 12 years, 22 other cases of ERATS were published worldwide. The indications were the same, except for esophagoplasty, which was not found. CONCLUSION Aside from accessibility issues with the robotic platform, the main limitation is still very much that the low body weight of children results in incompatibility between the size of the trocars and the size of the intercostal space. ERATS is clearly a feasible procedure with technical advantages for most pediatric cases with body weights more than 15 kg. A transdiaphragmatic abdominal approach should be considered for lower esophagus surgery.
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Affiliation(s)
| | - Thomas Blanc
- Department of Pediatric Surgery, Hôpital Universitaire Necker-Enfants malades, Paris, Île-de-France, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Centre Hospitalier Regional Universitaire de Tours, Tours, Centre Region, France
| | - Alexis Arnaud
- Department of Pediatric Surgery, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Olivier Abbo
- Department of Pediatric Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrénées, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery, Necker-Enfants Malades Hospitals, Paris, Île-de-France, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery, Robert-Debré Mother-Child University Hospital, Paris, Île-de-France, France
| | - Grazia Spampinato
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Centre Hospitalier Regional Universitaire de Tours, Tours, Centre Region, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
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Župčić M, Dedić D, Graf Župčić S, Đuzel V, Šimurina T, Šakić L, Grubješić I, Šutić I, Šutić I, Korušić A. THE ROLE OF PARAVERTEBRAL BLOCKS IN AMBULATORY SURGERY: REVIEW OF THE LITERATURE. Acta Clin Croat 2019; 58:43-47. [PMID: 31741558 PMCID: PMC6813485 DOI: 10.20471/acc.2019.58.s1.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ambulatory surgery often involves surgical procedures on the thorax, abdomen and limbs, which can be associated with substantial postoperative pain. The aim of this narrative review is to provide an analysis of the effectiveness of paravertebral block (PVB) alone or in combination with general anaesthesia, in this setting, with an emphasis on satisfactory postoperative analgesia in comparison to other modalities. We have conducted a search of current medical literature written in English through PubMed, Google Scholar and Ovid Medline®. Peer-reviewed professional articles, review articles, retrospective and prospective studies, case reports and case series were systematically searched for during the time period between November 2003 and February 2019. The literature used for the purpose of creating this review showed that utilisation of paravertebral block either alone or in combination with general anaesthesia, has a positive effect on satisfactory analgesia in ambulatory surgery. With a multimodal analgesic approach of PVB and other techniques of anaesthesia and analgesia there is a reduction in postoperative opioid consumption, fewer side effects, lower pain scores, decreased mortality, earlier mobilisation of patients and reduced hospital stay.
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Affiliation(s)
| | - David Dedić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Sandra Graf Župčić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Viktor Đuzel
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Tatjana Šimurina
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Livija Šakić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Igor Grubješić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Ingrid Šutić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Ivana Šutić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Andjelko Korušić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
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