BACKGROUND: Transition from the utilisation of traditional instruments to new robotic methodologies in surgical operations occurs rapidly. Although the implementation of these methodologies to classical surgery operations is advantageous due to increased precisions and enhanced motion capabilities of robotic systems, overall worldwide accessibility and adaptation are still limited due to high equipment costs and special infrastructure requirements. METHODOLOGY: The design of four degrees of freedom low cost, compact and portable manipulation system was proposed to allow the utilisation of commercial robotic surgery forceps like a conventional laparoscopy instrument without the necessity of bulky manipulation systems. RESULTS: The structural design of the system was carried out along with necessary kinematic and coupled motion analysis. Prototypes were constructed. Hardware verification of the system was executed using implemented control methodology. CONCLUSIONS: The proposed design successfully demonstrated the advantages of multi degree of freedom robotic surgery forceps in a portable handheld system compared to classical laparoscopy instruments.
Laparoscopy , Robotic Surgical Procedures , Robotics , Humans , Equipment Design , Robotics/methods , Laparoscopy/methods , Surgical Instruments
INTRODUCTION: The data of the Turkish Esophageal Atresia Registry (TEAR) was evaluated to define the outcome of very low birth weight (VLBW) and low BW (LWB) infants with esophageal atresia (EA). MATERIALS AND METHODS: The data registered by 24 centers between 2014 and 2018 were evaluated for demographic features, prenatal findings, associated anomalies, surgical treatment, and outcome. Patients were enrolled in three groups according to their BWs (VLBW <1,500 g), LWB = 1,500-2,500 g), and normal BW (NBW; >2,500 g). RESULTS: Among the 389 cases, there were 37 patients (9.5%) in the VLBW group, 165 patients (42.4%) in the LBW group, and 187 patients (48.1%) in the NBW group. Prenatal diagnosis rates were similar among the three groups (29.7, 34.5, and 24.6%, respectively). The standard primary anastomosis was achieved at a significantly higher rate in NWB cases than in the other groups (p < 0.05). In patients with tracheoesophageal fistula (TEF), patients of the NBW group had significantly higher rates of full oral feedings, when compared with VLBW and LBW cases (p < 0.05). At the end of the first year, when we evaluate all patients, the number of cases with fistula recanalization and esophageal anastomotic strictures (AS) requiring esophageal dilatation was similar among the groups. The weight and height measurements at 6 months and 1 year of age of the survivors were similar in all the groups. The overall mortality rate was significantly higher in the VLBW and LBW groups, when compared with the NBW patients, even in patients with tension-free anastomosis (p < 0.05). The incidence of the associated anomalies was 90.6% in cases with mortality, which was significantly higher than in survivors (59.6%; p < 0.05). According to Spitz's classification, the survival rate was 87.1% in class I, 55.3% in class II, and 16.7% in class III. The most common causes of mortality were associated with cardiovascular diseases, pneumonia, and sepsis. CONCLUSION: The national data of TEAR demonstrates that the developmental and feeding parameters are better in NBW patients. Although VLBW patients have higher risk of developing fistula canalization than the LBW and NBW groups, long-term complications, such as anastomotic strictures, weight, and height values, after 1 year are similar in both groups. According to our results, associated anomalies and LBWs are still significant risk factors for mortality in cases with EA.
Esophageal Atresia/surgery , Esophagoplasty , Infant, Low Birth Weight , Infant, Premature, Diseases/surgery , Postoperative Complications/etiology , Esophageal Atresia/diagnosis , Esophageal Atresia/mortality , Esophagoplasty/methods , Female , Follow-Up Studies , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/mortality , Infant, Very Low Birth Weight , Male , Postoperative Complications/epidemiology , Registries , Retrospective Studies , Risk Factors , Treatment Outcome , Turkey/epidemiology
PURPOSE: Laparoscopic appendectomy has become more popular compared with the open appendectomy in children, but there are limited data on the effects of pneumoperitoneum and Trendelenburg position on cerebral oxygenation. This study was designed to evaluate the changes in cerebral saturation using near-infrared spectroscope during laparoscopic surgery in children. METHODS: The children underwent laparoscopic (LAP Group, n=22) or open appendectomy (OPEN Group, n=22). Right and left cerebral oxygenation (RScO2-LScO2), heart rate (HR), mean arterial pressure (MAP), end-tidal CO2pressure (PETCO2), and peripheral oxygen saturations (SpO2) were recorded between anesthesia induction (T0, baseline), after induction (T1), after intubation (T2), 5 minutes after intubation (T3), 5 minutes after pneumoperitoneum-15th minute at OPEN (T4), 5 minutes after Trendelenburg-20th minute at OPEN (T5), 30 minutes after pneumoperitoneum-45th minute at OPEN (T6), 5 minutes after supine position-skin suturing at OPEN (T7), 5 minutes postextubation (T8). RESULTS: Groups were similar with respect to their demographic data. In LAP group, a significant increase in HR was recorded at T5. No significant difference was observed in the MAP, PETCO2, SpO2, RScO2, and LScO2 values between the groups. There was a significant increase in the perioperative T1 to T8 values compared with the T0 values in LScO2 of the LAP group. CONCLUSIONS: Our results suggest that pneumoperitoneum and Trendelenburg position does not alter the hemodynamic values and can be safely performed in children without altering regional brain oxygenation levels.
Brain Chemistry/physiology , Head-Down Tilt/physiology , Laparoscopy , Oxygen/blood , Adolescent , Appendectomy/methods , Blood Pressure/physiology , Carbon Dioxide/therapeutic use , Child , Child, Preschool , Female , Heart Rate/physiology , Humans , Insufflation/methods , Intraoperative Care , Male , Monitoring, Intraoperative , Operative Time , Pneumoperitoneum, Artificial
La paniculitis epiploica aislada es una entidad rara, mayormente observada en los adultos. Se presenta con inflamación del tejido adiposo del epiplón. Los síntomas varían entre manifestaciones locales (por ejemplo, dolor a la palpación abdominal o una masa palpable) y sistémicas, que incluyen dolor abdominal, dolor de espalda, fiebre, descenso de peso y trastornos intestinales. Presentamos este caso como una primera acción de sensibilización respecto de un caso de paniculitis epiploica en un niño, afección que debe tenerse en cuenta en el diagnóstico diferencial del íleo a fin de evitar cirugías innecesarias.
Isolated omental panniculitis is a rare entity mostly seen in adults. It presents with the inflammation of the fatty tissue of the omentum. The symptoms may vary from local (e.g. abdominal tenderness or palpable mass) to systemic manifestations including abdominal pain, back pain, fever, weight loss and bowel disturbances. We presented this case as a first awareness of omental panniculitis in a child which must be kept in mind at the differential diagnosis of ileus so that unnecessary surgeries might be avoided.
Humans , Male , Adolescent , Panniculitis, Peritoneal/diagnosis , Panniculitis, Peritoneal/complications , Abdominal Pain/etiology
Isolated omental panniculitis is a rare entity mostly seen in adults. It presents with the inflammation of the fatty tissue of the omentum. The symptoms may vary from local (e.g. abdominal tenderness or palpable mass) to systemic manifestations including abdominal pain, back pain, fever, weight loss and bowel disturbances. We presented this case as a first awareness of omental panniculitis in a child which must be kept in mind at the differential diagnosis of ileus so that unnecessary surgeries might be avoided.
La paniculitis epiploica aislada es una entidad rara, mayormente observada en los adultos. Se presenta con inflamación del tejido adiposo del epiplón. Los síntomas varían entre manifestaciones locales (por ejemplo, dolor a la palpación abdominal o una masa palpable) y sistémicas, que incluyen dolor abdominal, dolor de espalda, fiebre, descenso de peso y trastornos intestinales. Presentamos este caso como una primera acción de sensibilización respecto de un caso de paniculitis epiploica en un niño, afección que debe tenerse en cuenta en el diagnóstico diferencial del íleo a fin de evitar cirugías innecesarias.
Panniculitis, Peritoneal/diagnosis , Abdominal Pain/etiology , Adolescent , Humans , Male , Panniculitis, Peritoneal/complications
Umbilical venous catheterization has become a widely accepted intravenous route for premature babies. These catheters allow administration of parenteral nutrition and medication and facilitate blood sampling. Besides these benefits, they also have significant potential complications like portal vein thrombosis, infection, vascular or hepatic injury, arrhythmia and sepsis. One of the rare but important complication is extravasation of the fluids due to misplacement of the catheter. The typical symptoms of this condition are sudden deterioration, hepatic enlargement, hematocrit drop, hypotension and abdominal distension. We herein present a premature newborn with unusual acute abdomen findings suggesting a surgical pathology after the extravasation of total parenteral nutrition into the abdomen.
El cateterismo venoso umbilical se ha convertido en una vía intravenosa ampliamente aceptada para los recién nacidos prematuros. Estos tipos de sondas permiten la alimentación parenteral y la administración de medicamentos y facilitan la obtención de muestras de sangre. Además de estos beneficios, también conllevan complicaciones significativas, tales como trombosis de la vena porta, infección, lesión hepática o vascular, arritmia y septicemia. Una complicación rara, aunque importante, es la extravasación de líquido debido a la mala colocación del catéter. Los síntomas típicos de esta afección incluyen deterioro súbito, hepatomegalia, descenso brusco del hematocrito, hipotensión y distensión abdominal. En este artículo presentamos el caso de una recién nacida prematura con signos inusuales de abdomen agudo, indicativos de una patología quirúrgica luego de la extravasación de la nutrición parenteral total hacia el abdomen.
Abdomen, Acute/etiology , Catheterization/adverse effects , Parenteral Nutrition , Female , Humans , Infant, Newborn , Umbilical Veins
