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Ugolini S, Coletta R, Lo Piccolo R, Dell'Otto F, Voltolini L, Gonfiotti A, Morabito A. Uniportal Video-Assisted Thoracic Surgery in a Pediatric Hospital: Early Results and Review of the Literature. J Laparoendosc Adv Surg Tech A 2022; 32:713-720. [PMID: 34990275 DOI: 10.1089/lap.2021.0180] [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: 10/19/2022] Open
Abstract
Background: Uniportal video-assisted thoracic surgery (U-VATS) is an implemented technique in adult surgery that may aid to extend offer the benefits of thoracoscopy to a wide number of pediatric patients. Materials and Methods: Consecutive cases treated between July 2019 and July 2021 were retrospectively analyzed. Simultaneously, a MEDLINE systematic search was conducted. Results: Twelve patients (median age 13 years, median weight 44.5 kg) underwent 4 major procedures (n = 2 lobectomy, n = 2 segmentectomy) and 11 minor procedures (n = 1 bronchogenic cyst resection, n = 4 apical wedge resections and pleurodesis for pneumothorax, n = 4 wedge resections for lung nodules, and n = 2 debridement for empyema). The median observed operative time was 77 minutes. We recorded one conversion to biportal VATS. No intraoperative complications or 30-day morbidity-mortality was reported. A rate of 40% adverse postoperative events was observed (Clavien-Dindo grade I-IVa). Visual analog scale for postoperative pain recorded a median value of 0 on days 1, 2, and 3. The systematic review provided 15 full-text articles reporting 76 pediatric interventions (4 major and 72 minor procedures); among them, 1 biportal conversion, 3 mild postoperative complications, and 1 redo surgery are presented. Conclusions: As emerged from the literature review, U-VATS remains scarcely adopted by pediatric surgeons. Its feasibility is supported by the four reported major lung resections plus the four cases added on by our series. Thanks to a more rapid learning curve over conventional VATS, the uniportal technique could be accessible to a wider number of centers.
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Affiliation(s)
- Sara Ugolini
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy.,School of Environment and Life Science, University of Salford, Salford, United Kingdom
| | - Roberto Lo Piccolo
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy
| | - Fabio Dell'Otto
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Luca Voltolini
- Department of Thoracic Surgery, University Hospital Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine (DMSC), University of Florence, Florence, Italy
| | - Alessandro Gonfiotti
- Department of Thoracic Surgery, University Hospital Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine (DMSC), University of Florence, Florence, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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Sacks MA, Goodman LF, Mendez YS, Khan FA, Radulescu A. Pain versus Gain: Multiport versus single-port thoracoscopic surgery for pediatric pneumothorax a case series. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Uniportal video-assisted thoracoscopic surgery in a two-year-old chronic empyema patient: challenges faced in the first case from the Indian subcontinent. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:177-179. [PMID: 34703476 PMCID: PMC8525282 DOI: 10.5114/kitp.2021.109402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022]
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Souza JM, Pereira IRPD, Borgmann AV, Chiaradia RE, Boscardim PCB. Uniportal surgical biopsy, without orotraqueal intubation, without thoracic drainage in intersticial pulmonary disease: initial results. Rev Col Bras Cir 2021; 48:e20202914. [PMID: 34133610 PMCID: PMC10683432 DOI: 10.1590/0100-6991e-20202914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/01/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE interstitial lung disease comprises a group of lung diseases with wide pathophysiological varieties. This paper aims to report the video thoracoscopic surgical biopsy in patients with interstitial lung disease through a single minimal chest incision, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers. METHODS this study is a series of 14 cases evaluated retrospectively, descriptively, where patients underwent a pulmonary surgical biopsy from January 2019 to January 2020. The patients included in the study had diffuse interstitial lung disease without a defined etiological diagnosis. RESULTS none of the patients had transoperative complications, there was no need for chest drainage in the postoperative period, and the patients pain, assessed using the verbal scale, had a mode of 2 (minimum value of 1 and maximum of 4) in the post immediate surgery and 1 (minimum value of 1 and maximum of 3) at the time of hospital discharge. The length of hospital stay was up to 24 hours, with 12 patients being discharged on the same day of hospitalization. CONCLUSION therefore, it is concluded in this series of cases that the performance of uniportal video-assisted thoracoscopic surgery procedures to perform lung biopsies, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers, bring benefits to the patient without compromising his safety. Further larger studies are necessary to confirm the safety and efficiency of this method.
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Affiliation(s)
- Juliano Mendes Souza
- - Faculdades Pequeno Príncipe, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Nossa Senhora das Graças, Departamento de Cirurgia Torácica - Curitiba - PR - Brasil
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El-Gohary Y, Mansfield S, Talbot L, Murphy AJ, Davidoff AM, Abdelhafeez A. Single-site retroperitoneoscopy in pediatric metastatic lymphadenopathy. J Pediatr Surg 2020; 55:2430-2434. [PMID: 32276851 DOI: 10.1016/j.jpedsurg.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/10/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Retroperitoneoscopic surgery (RS) is increasingly used for the diagnosis, staging, and treatment of solid tumors, but rarely in pediatric surgical oncology for retroperitoneal lymph node dissection (RPLND). Herein, we use single-site RS for RPLND in children and compare the perioperative outcomes with those for the transperitoneal laparoscopic approach (TPLA). METHODS A single institution retrospective chart review was performed for patients undergoing single-site RS and TPLA (January 2018 till June 2019). We compared patient demographics, diagnoses, operative times, complications, postoperative analgesia, and length of hospital stay between both groups. RESULTS Eight patients (median age of 16.5 years) undergoing single-site RS for RPLND and five patients (median age 17 years) undergoing TPLA RPLND were compared. Groups were comparable in age, median operative duration (232 vs 234 min, p = 0.77), and complications (1 vs 1, p = 0.72). Median postoperative hospital stay and total morphine equivalent doses used postoperatively were significantly lower in the RS group, (0.5 vs 2 days, [p = 0.03] and 0.1 vs 0.4 mg/kg [p = 0.01], respectively). Eight patients underwent ipsilateral modified template RPLND for paratesticular RMS (six single-site RS and two TPLA) and lymph node metastases were found in 50% of these patients. The rest were resections of metastatic lesions for germ cell tumor and neuroblastoma (two single-site RS and three TPLA). CONCLUSIONS Single-site RS is a safe and feasible technique in carefully selected pediatric surgical oncology patients. RS provides an excellent view of the retroperitoneum, requires less postoperative analgesia, and is associated with faster recovery. LEVEL OF EVIDENCE RATING IV.
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Affiliation(s)
- Yousef El-Gohary
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA.
| | - Sara Mansfield
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA
| | - Lindsay Talbot
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
| | - Abdelhafeez Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, Memphis, TN 38105, USA
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Won TM, Muñoz A, Sacks MA, Mendez YS, Goodman L, Khan FA, Radulescu A. Single site video assisted thoracoscopic wedge resection for spontaneous pneumothorax in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Phelps HM, Lovvorn HN. Minimally Invasive Surgery in Pediatric Surgical Oncology. CHILDREN-BASEL 2018; 5:children5120158. [PMID: 30486309 PMCID: PMC6306705 DOI: 10.3390/children5120158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 02/06/2023]
Abstract
The application of minimally invasive surgery (MIS) to resect pediatric solid tumors offers the potential for reduced postoperative morbidity with smaller wounds, less pain, fewer surgical site infections, decreased blood loss, shorter hospital stays, and less disruption to treatment regimens. However, significant controversy surrounds the question of whether a high-fidelity oncologic resection of childhood cancers can be achieved through MIS. This review outlines the diverse applications of MIS to treat pediatric malignancies, up to and including definitive resection. This work further summarizes the current evidence supporting the efficacy of MIS to accomplish a definitive, oncologic resection as well as appropriate patient selection criteria for the minimally invasive approach.
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Affiliation(s)
- Hannah M Phelps
- School of Medicine, Vanderbilt University, Nashville, TN 37232, USA.
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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