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1.
Surg Endosc ; 38(2): 475-487, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38180541

RESUMO

BACKGROUND: Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas. METHODS: This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology. RESULTS: In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth. CONCLUSION: Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.


Assuntos
Procedimentos Cirúrgicos Robóticos , Cirurgiões , Humanos , Inteligência Artificial , Aprendizado de Máquina , Previsões
2.
Nat Rev Dis Primers ; 9(1): 60, 2023 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-37919294

RESUMO

Congenital lung malformations (CLMs) are rare developmental anomalies of the lung, including congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst and isolated congenital bronchial atresia. CLMs occur in 4 out of 10,000 live births. Postnatal presentation ranges from an asymptomatic infant to respiratory failure. CLMs are typically diagnosed with antenatal ultrasonography and confirmed by chest CT angiography in the first few months of life. Although surgical treatment is the gold standard for symptomatic CLMs, a consensus on asymptomatic cases has not been reached. Resection, either thoracoscopically or through thoracotomy, minimizes the risk of local morbidity, including recurrent infections and pneumothorax, and avoids the risk of malignancies that have been associated with CPAM, bronchopulmonary sequestration and bronchogenic cyst. However, some surgeons suggest expectant management as the incidence of adverse outcomes, including malignancy, remains unknown. In either case, a planned follow-up and a proper transition to adult care are needed. The biological mechanisms through which some CLMs may trigger malignant transformation are under investigation. KRAS has already been confirmed to be somatically mutated in CPAM and other genetic susceptibilities linked to tumour development have been explored. By summarizing current progress in CLM diagnosis, management and molecular understanding we hope to highlight open questions that require urgent attention.


Assuntos
Cisto Broncogênico , Sequestro Broncopulmonar , Malformação Adenomatoide Cística Congênita do Pulmão , Pneumopatias , Lactente , Feminino , Humanos , Gravidez , Cisto Broncogênico/diagnóstico , Cisto Broncogênico/cirurgia , Sequestro Broncopulmonar/diagnóstico , Sequestro Broncopulmonar/cirurgia , Pulmão/diagnóstico por imagem , Pulmão/anormalidades , Malformação Adenomatoide Cística Congênita do Pulmão/terapia , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia
3.
J Laparoendosc Adv Surg Tech A ; 31(10): 1157-1161, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34609926

RESUMO

Indications for pulmonary lobectomy in infants and children include cystic pulmonary adenomatoid malformation, congenital lobar emphysema, chronic infection, and malignancy. These procedures can now all be done thoracoscopically avoiding the short- and long-term morbidity of an open thoracotomy. In this article we describe the technique of thoracoscopic lobectomy as well as the preoperative and postoperative care.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão , Enfisema Pulmonar , Criança , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Humanos , Lactente , Pulmão/cirurgia , Pneumonectomia , Enfisema Pulmonar/cirurgia , Toracotomia , Resultado do Tratamento
4.
Semin Pediatr Surg ; 28(3): 178-182, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171154

RESUMO

Growing adoption of thoracoscopy by pediatric surgeons has resulted in increasingly complex operations being performed. Although common complications of these procedures have decreased with experience, surgeons are still at risk to fall into error traps where routine practice in uncommon situations results in unanticipated complications. A background culture of safety that rewards multidisciplinary communication, teamwork, openness and standardization of care can assist surgeons to recognize, address and report error traps when they arise. This article serves to encourage a culture of safety and raise awareness of error traps in pediatric thoracoscopy to minimize potential harm and improve quality of care.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Erros Médicos , Segurança do Paciente/normas , Toracoscopia/normas , Criança , Pré-Escolar , Humanos , Lactente , Complicações Intraoperatórias/etiologia , Toracoscopia/efeitos adversos , Toracoscopia/métodos
5.
J Laparoendosc Adv Surg Tech A ; 28(6): 780-783, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29446703

RESUMO

OBJECTIVE: Laparoscopic anorectoplasty (LARRP) for the treatment of select anorectal malformations has gained popularity due to enhanced visualization of the fistula and the ability to place the rectum within the sphincter complex while minimizing division of muscles and the perineal incision. However, given the technical challenges and reported complications of ligation, a number of techniques have been described, including using clips, suture ligation, endoloops, or division without closure. We aimed to evaluate fistula closure and division for high imperforate anus using a 5-mm stapler (JustRight Surgical, Boulder, CO). MATERIALS AND METHODS: A retrospective chart review was performed on patients who underwent LAARP for imperforate anus between March 2015 and December 2016. RESULTS: Four patients underwent LAARP with division of the fistula using the 5-mm stapler. The average age was 3.2 months and average weight was 4.5 kg. The location of the fistula was rectoprostatic in 3 cases and rectobladder neck in 1 case. There were no complications. CONCLUSION: Division of a fistula at or above the level of the prostate can safely and effectively be performed with the 5-mm stapler. The stapler allows for division flush with the urethra or bladder ergonomically and quickly.


Assuntos
Anus Imperfurado/cirurgia , Laparoscopia/métodos , Procedimentos de Cirurgia Plástica/métodos , Fístula Retal/cirurgia , Grampeadores Cirúrgicos/efeitos adversos , Feminino , Humanos , Lactente , Ligadura/métodos , Masculino , Reto/cirurgia , Estudos Retrospectivos
6.
J Pediatr Surg ; 2017 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-29092772

RESUMO

PURPOSE: This study evaluates the results of thoracoscopic management of complex, non-type C, EA and TEF in infants. METHODS: From March 2000 to February 2017, 23 patients were treated for Type A N=13, Type B N=4, and Type E N=6. Patients diagnosed with EA had G-tube feeds for a period of 4-9weeks. All procedures were performed thoracoscopically. EA gaps were between 4 and 7 1/2 vertebral bodies. RESULTS: All surgeries were completed thoracoscopically. Average operative time was 95min for Type A, 115min for Type B, and 50min for Type E. Two patients with long gaps had small leaks which resolved with conservative management. One patient with an H-type was re-intubated causing a partial disruption of the tracheal repair. This required thoracoscopic re-exploration with repair and placement of an intercostal muscle flap. No patient has any clinical evidence of fused ribs, chest wall asymmetry, shoulder girdle weakness, or winged scapula. CONCLUSION: Thoracoscopic repair of complex EA and TEF is safe and effective. The excellent visualization of the thoracic inlet allows for extensive mobilization creating sufficient length for long gaps and safely managing high fistulas. This may limit injury to adjacent structures and avoid a neck incision and chest wall deformity. LEVEL OF EVIDENCE: IV.

7.
Clin Perinatol ; 44(4): 795-803, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29127961

RESUMO

Gastroesophageal reflux disease (GERD) is a common condition in infants. Symptoms from pathologic GERD include regurgitation, irritability when feeding, failure to thrive, and respiratory problems. Treatment typically starts with dietary modifications and postural changes. Antireflux medications may then be added. Indications for operative management in neonates and infants include poor weight gain, failure to thrive, acute life-threatening events, and continued respiratory symptoms. Laparoscopic Nissen fundoplication has become the standard of care for surgical treatment of children with GERD. In this procedure, the fundus of the stomach is wrapped 360° posteriorly around the lower esophagus.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Dietoterapia/métodos , Impedância Elétrica , Insuficiência de Crescimento/etiologia , Refluxo Gastroesofágico/diagnóstico , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Laparoscopia , Posicionamento do Paciente/métodos , Inibidores da Bomba de Prótons/uso terapêutico , Radiografia
8.
Semin Pediatr Surg ; 26(2): 56-60, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28550871

RESUMO

Gastroesophageal reflux disease (GERD) is a very common condition and affects approximately 7-20% of the pediatric population. Symptoms from pathological GERD include regurgitation, irritability when feeding, respiratory problems, and substernal pain. Treatment typically starts with dietary modifications and postural changes. Antireflux medications may then be added. Indications for operative management in the pediatric population include failure of medical therapy with poor weight gain or failure to thrive, continued respiratory symptoms, and complications such as esophagitis. Laparoscopic Nissen fundoplication has become the standard of care for surgical treatment of children with GERD. The key technical aspects of laparoscopic Nissen fundoplication include creation of an adequate intra-abdominal esophagus, minimal dissection of the hiatus with exposure of the right crus to identify the gastroesophageal junction, crural repair, and creation of floppy, 360° wrap that is oriented at the 11 o׳clock position.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Criança , Refluxo Gastroesofágico/diagnóstico , Humanos
9.
J Laparoendosc Adv Surg Tech A ; 27(4): 438-440, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28099058

RESUMO

PURPOSE: Laparoscopic appendectomy is one of the most common operations. Single-site appendectomy has been gaining popularity; however, it has certain disadvantages. The purpose of this study was to review the results of an essentially scarless laparoscopic appendectomy technique. METHODS: A retrospective review of all patients who underwent two-site appendectomy for appendicitis between January 2015 and February 2016 was performed. For all cases, a 4 mm trocar and a 5 mm trocar were placed through an infraumbilical incision and a 3 mm trocar was placed in the suprapubic region. RESULTS: Fifty patients underwent appendectomy using this technique. The average age was 9.7 years (5-16 years) and average weight was 40 kg (15.7-73.3 kg). The classifications of appendicitis consisted of 32 simple, 5 suppurative, 4 gangrenous, and 8 perforated. The average operative time was 29 minutes (6-53 minutes) and average length of stay was 1.9 days (1-6 days). There were three minor complications, and all cases were completed with this technique, including in obese patients and for perforated appendicitis. All patients reported satisfaction with their postoperative cosmetic outcome. CONCLUSIONS: This technique allows for the main incision to be hidden at the umbilicus, creating an essentially scarless cosmetic result. The addition of a 3 mm suprapubic port leads to increased maneuverability of the instruments and better retraction of the appendix. It is also feasible in obese children and cases of perforated appendicitis.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Adolescente , Apendicite/complicações , Apêndice/patologia , Apêndice/cirurgia , Criança , Pré-Escolar , Feminino , Gangrena/cirurgia , Humanos , Laparoscopia/métodos , Masculino , Obesidade/complicações , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Umbigo
10.
Semin Pediatr Surg ; 25(3): 176-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27301604

RESUMO

Tracheoesophageal fistula (TEF) is a relatively rare congenital anomaly. Surgical intervention is required to establish esophageal continuity and prevent aspiration and overdistension of the stomach. Since the first successful report of thoracoscopic TEF repair in 2000, the minimally invasive approach has become increasingly utilized. The main advantages of the thoracoscopic technique include avoidance of a thoracotomy, improved cosmesis, and superior visualization of the anatomy and fistula afforded by the laparoscope׳s magnification.


Assuntos
Toracoscopia/métodos , Fístula Traqueoesofágica/cirurgia , Humanos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias , Toracotomia
11.
J Laparoendosc Adv Surg Tech A ; 26(1): 66-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26312644

RESUMO

INTRODUCTION: Both patent ductus arteriosus (PDA) and vascular rings often require surgical treatment to prevent complications and alleviate symptoms, respectively. Management in infants and children has traditionally required an open thoracotomy. However, given the known advantages of the thoracoscopic approach, increased technical experience, and improved instrumentation, the minimally invasive technique to repair these thoracic vascular anomalies has grown in popularity. SUBJECTS AND METHODS: We report our experience with thoracoscopic PDA ligation and vascular ring division at a single institution. From October 1993 to March 2014, 78 patients underwent thoracoscopic PDA ligation, and 13 patients presented with vascular rings. Ages ranged from 2 days to 17 years (mean, 18 months), and weights ranged from 2 to 60 kg (mean, 8.5 kg) for the thoracoscopic PDA group, whereas ages ranged from 6 weeks to 13 years (mean, 19 months), and weights ranged from 3.6 to 38 kg (mean, 10 kg) for the thoracoscopic vascular ring division group. In the thoracoscopic PDA group, the mean operative time was 36 minutes. Complications consisted of one death not related to the procedure, one conversion to open for a torn ductus, one recurrence requiring re-operative thoracoscopic repair, and one residual PDA requiring cardiac catheterization with occlusion. In the vascular ring group, one procedure was unable to be completed thoracoscopically and was converted to open. In 2 cases, thoracoscopic exploration revealed no significant compression from the vascular ring, and dissection was stopped. CONCLUSIONS: Thoracoscopic closure of PDA and division of vascular rings are safe and effective techniques that minimize physiologic and cosmetic adverse effects.


Assuntos
Anormalidades Múltiplas/cirurgia , Permeabilidade do Canal Arterial/cirurgia , Toracoscopia/métodos , Malformações Vasculares/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Ligadura/métodos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
12.
J Laparoendosc Adv Surg Tech A ; 26(1): 75-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26698191

RESUMO

PURPOSE: Although surgical residency training is a structured, regulated system for surgical skill acquisition, after residency or fellowship, no good method exists for practicing surgeons to learn new, developing techniques. Because 1-2-day simulation courses are probably inadequate for teaching a new technique and because it is often unrealistic for a practicing surgeon to leave his or her practice for an extended period of time, surgical telementoring may be a solution by allowing an expert to support a trained surgeon through the learning curve of a new procedure while overcoming geographic distance. In the past we have presented 6 cases of transcontinental telementoring with pediatric surgeons in the United States. We have since expanded the concept to trans-Atlantic telementoring and performed 2 cases with pediatric surgeons in France. MATERIALS AND METHODS: The two telementors and one of the two telementees had previously met through a professional society but had never operated together before this experience. The first procedure was an interval laparoscopic appendectomy to test the process. The second procedure was a thoracoscopic total thymectomy. The technology consisted of the VisitOR1® telementoring robot (Karl Storz GmbH & Co. KG, Tuttlingen, Germany). RESULTS: Both procedures were completed successfully with high satisfaction from both the telementors and telementees. Latency was low, and there was no loss of connection. The telestration and laser pointer features of the robot facilitated the telementoring experience. Challenges included lack of a prior surgical relationship between the mentees and mentors that limited the depth of advice but did not impair the quality of the surgery, as well as poor audio quality that was overcome using headsets. CONCLUSIONS: From this experience, several challenges were identified and addressed. Telementoring may be an effective means of improving adoption of new surgical techniques, ultimately improving patient care.


Assuntos
Educação Médica Continuada/métodos , Cooperação Internacional , Laparoscopia/educação , Mentores , Pediatria/educação , Especialidades Cirúrgicas/educação , Telemedicina/métodos , Apendicectomia/educação , Apendicectomia/métodos , Criança , Pré-Escolar , Feminino , França , Humanos , Laparoscopia/métodos , Masculino , Timectomia/educação , Timectomia/métodos , Estados Unidos
13.
J Laparoendosc Adv Surg Tech A ; 25(11): 932-5, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26485521

RESUMO

INTRODUCTION: This report evaluates the results of a two-surgeon experience with thoracoscopic repair in patients with long gap esophageal atresia (EA). MATERIALS AND METHODS: From March 2000 to February 2015, 14 consecutive patients with pure EA were repaired thoracoscopically. The gap length was then evaluated by contrast gastrostomy tube study. Patients were operated on between 4 to 8 weeks of age. Patient weights ranged from 2.6 to 3.8 kg. The longest gap was 7½ vertebral bodies. Dissection was carried well up into the thoracic inlet on the upper pouch and down to the esophageal hiatus on the lower pouch. A 15th patient was not referred until 3 months of age. RESULTS: All 15 procedures were completed successfully thoracoscopically. Operative times ranged from 60 to 135 minutes. There were two leaks; both resolved with conservative therapy. Feeds were started on Day 5 in all other patients. Six of 13 patients required dilations (one to nine), and 8 required a Nissen fundoplication for severe reflux. All patients are currently on full oral feeds. No patient has any evidence of chest wall asymmetry, winged scapula, or clinically significant scoliosis. CONCLUSIONS: Thoracoscopic repair of long gap EA has proven to be an effective and safe technique when performed in the first 2 months of life. The improved visualization and access to the upper pouch and lower pouches allow for maximal mobilization. The results are superior to those of documented open series and avoid the morbidity of repeated operations in the neonatal period.


Assuntos
Atresia Esofágica/cirurgia , Gastrostomia/métodos , Toracoscopia/métodos , Feminino , Humanos , Recém-Nascido , Masculino , Duração da Cirurgia , Resultado do Tratamento
14.
Semin Pediatr Surg ; 24(3): 124-9, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25976148

RESUMO

The need for education does not end with residency. Practicing surgeons must find ways to stay current. The boom in new technologic developments may significantly enhance our methods of teaching through the use of new mutli-media. Here we will explore some of the muti-media innovations that have or may have the greatest impact on surgical education. Live, interactive, and online forums have proven to be effective new methods of bringing people together to discuss and learn new concepts in medicine. These forums allow physicians to interact with key opinion leaders and flatten knowledge sharing, so that everyone may have a voice. The dynamic, fast paced, and interactive format allows for screen-based learning to be engaging and interactive. Information is now available online in multiple formats that are continuously updated, so that information is no longer outdated by the time it is published in a textbook. Multi-media is now being used to disseminate content through, archived video, live video, as well as audiocasts. All of these are creating more modern ways for physicians to stay up-to-date either at home, in the office, or when mobile. Lastly, new advanced, interactive, technology can allow experts to assist less-experienced surgeons as "virtual partners" through telementoring. With telementoring, an expert can be virtually present while another surgeon is performing a complex, new, operation, and the expert can help with voice suggestions and on-screen telestration. Pediatric surgical education has made a giant leap thanks to new developments in multi-media technology.


Assuntos
Cirurgia Geral/educação , Multimídia/normas , Comunicação por Videoconferência/normas , Humanos
16.
J Pediatr Surg ; 50(2): 232-5, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25638608

RESUMO

The field of minimally invasive surgery (MIS) in neonates and infants is a relatively new field, evolving over the last 20years. This has required the development of not only new techniques but new instruments. The process has resulted in a unique partnership between pediatric minimally invasive surgeons and industry, as both groups have struggled to find the right mix of need, technical viability, and economic sustainability. The results have spawned a new generation of MIS instrumentation that not only enables the neonatal MIS surgeon but also leads the way in the field of mini-laparoscopy in children and adults.


Assuntos
Laparoscopia/tendências , Indústria Manufatureira/tendências , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Humanos , Recém-Nascido , Laparoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
17.
J Pediatr Surg ; 50(2): 240-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25638610

RESUMO

Controversy exists over the best method and technique of repair of oesophageal atresia and diaphragmatic hernia. Open surgical repairs have a long established history of over 60 years of experience. Set against this has been a series of successful thoracoscopic repairs of both congenital anomalies reported over the past decade. This review was based upon a four-handed debate on the merits and weaknesses of the two contrasting surgical philosophies and reviews existing literature, techniques, complications, and importantly outcome and results.


Assuntos
Atresia Esofágica/cirurgia , Esôfago/cirurgia , Hérnias Diafragmáticas Congênitas/cirurgia , Herniorrafia/métodos , Procedimentos de Cirurgia Plástica/métodos , Toracoscopia/métodos , Humanos , Lactente , Resultado do Tratamento
18.
J Laparoendosc Adv Surg Tech A ; 25(5): 423-8, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25560086

RESUMO

OBJECTIVES: This study evaluates the safety and efficacy of thoracoscopic lobectomy in infants and children. MATERIALS AND METHODS: From January 1994 to November 2013, 347 patients underwent video-assisted thoracoscopic lobe resection at two institutions. All procedures were performed by or under the direct guidance of a single surgeon. Patients' ages ranged from 1 day to 18 years, and weights ranged from 2.8 to 78 kg. Preoperative diagnosis included sequestration/congenital pulmonary airway malformation (n=306), severe bronchiectasis (n=24), congenital lobar emphysema (n=13), and malignancy (n=4). RESULTS: Of the 347 procedures, 342 were completed thoracoscopically. Operative times ranged from 35 minutes to 240 minutes (average, 115 minutes). Average operative time when a trainee was the primary surgeon was 160 minutes. There were 81 upper, 25 middle, and 241 lower lobe resections. There were four intraoperative complications (1.1%) requiring conversion to an open thoracotomy. The postoperative complication rate was 3.3%, and 3 patients required re-exploration for a prolonged air leak. Hospital length of stay (LOS) ranged from 1 to 16 days (average). In patients <5 kg and <3 months of age, the average operative time was 90 minutes, and the LOS was 2.1 days. CONCLUSIONS: Thoracoscopic lung resection is a safe and efficacious technique. With proper mentoring it is an exportable technique, which can be performed by pediatric surgical trainees. The procedures are safe and effective even when performed in the first 3 months of life. Early resection avoids the risk of later infection and malignancy.


Assuntos
Neoplasias Pulmonares/cirurgia , Pulmão/cirurgia , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Adolescente , Bronquiectasia/cirurgia , Criança , Pré-Escolar , Conversão para Cirurgia Aberta , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/cirurgia , Tempo de Internação , Pulmão/anormalidades , Duração da Cirurgia , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Enfisema Pulmonar/congênito , Enfisema Pulmonar/cirurgia , Reoperação , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos
19.
J Laparoendosc Adv Surg Tech A ; 25(7): 605-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25629239

RESUMO

PURPOSE: Congenital and acquired chylothorax presents a unique management challenge in neonates and infants. A failure of conservative therapy requires surgical ligation to prevent continued fluid and protein losses. This article examines a 15-year experience with thoracoscopic ligation of the thoracic duct. PATIENTS AND METHODS: From June 1999 to December 2013, 21 patients presented with chylothorax refractory to conservative management. Sixteen patients presented following cardiac procedures, 1 after tracheoesophageal fistula repair, 1 after extracorporeal membrane oxygenation cannulation, and 1 after trauma, and 2 had congenital chylothorax. Ages ranged from 3 weeks to 5 years, and weights ranged from 2.6 to 12.7 kg. All procedures were performed in the right chest with three ports. All cases consisted of sealing of the duct at the level of the diaphragm, a mechanical pleurodesis, and fibrin glue. RESULTS: All cases were completed successfully thoracoscopically. Operative time ranged from 20 to 55 minutes. There were no intraoperative complications. One patient with congenital bilateral chylothorax required a left partial pleurectomy. The chest tube duration postoperatively ranged from 4 to 14 days. Ligation failed in 2 patients, requiring a subsequent thoracoscopic pleurectomy and chemical pleurodesis, respectively. CONCLUSIONS: Thoracoscopic thoracic duct ligation is a safe and effective procedure even in post-cardiac surgery patients. The site of the leak can be identified in the majority of cases, and tissue-sealing technology appears to be effective. The minimally invasive nature of the procedure has led to more expedient operative repair to avoid the morbidity associated with chyle leak.


Assuntos
Quilotórax/terapia , Pleurodese , Ducto Torácico/cirurgia , Toracoscopia/métodos , Tubos Torácicos , Pré-Escolar , Quilotórax/congênito , Quilotórax/etiologia , Adesivo Tecidual de Fibrina/administração & dosagem , Humanos , Lactente , Recém-Nascido , Ligadura/efeitos adversos , Ligadura/métodos , Duração da Cirurgia , Retratamento , Toracoscopia/efeitos adversos , Fatores de Tempo , Adesivos Teciduais/administração & dosagem , Falha de Tratamento
20.
J Laparoendosc Adv Surg Tech A ; 24(12): 892-6, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25423091

RESUMO

PURPOSE: To evaluate different technologies that can facilitate telementoring in a variety of pediatric surgical procedures. MATERIALS AND METHODS: Two different telementoring technologies were used to provide two-way audio and visual communication between experienced pediatric surgeon mentors located in another city and less experienced trainees performing a surgical procedure. The first technology consisted of store-bought equipment that connected the operating room laparoscope to a Skype™ (Microsoft, Redmond, WA) connection (used in 1 case), whereas the second was a proprietary telementoring robot, Karl Storz Endoscopy-America, Inc. VisitOR1(®) (Karl Storz GmbH & Co. KG, Tuttlingen, Germany) (used in 5 cases). The procedures included a video-assisted thoracic surgery lower lobectomy, a temporary and two permanent gastric stimulator placements, and two laparoscopic inguinal hernia repairs and were performed by pediatric surgeons (3 cases), a pediatric gastroenterologist (1 case), and a general surgeon (2 cases) under the guidance of pediatric surgeon mentors. RESULTS: All procedures were completed successfully in a time-efficient manner, without loss of transmission and without complications. Although the Skype technology was less costly, it lacked telestrator capacity and was not adequately secure. The VisitOR1 telementoring robot enabled high-resolution video communication, had telestrator capacity, and allowed pointing during the procedure. The mentors assisted with trocar placement, modifying the surgical technique, identifying planes of dissection, and indicating locations of device and suture placement. CONCLUSIONS: Telementoring is a useful adjunct in the field of pediatric surgery that can aid in the transfer of surgical skills remotely and shorten the time to implementation of new surgical techniques into practice. Optimal telementoring technology should have a secure wireless connection, high video resolution, and minimal bandwidth latency.


Assuntos
Laparoscopia/métodos , Monitorização Intraoperatória/métodos , Mídias Sociais , Cirurgiões , Telemetria/métodos , Criança , Humanos
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