A novel low cost minimally invasive surgical system allows for the translation of modern pediatric surgical technology to low- and middle-income nations.

BACKGROUND: There is a critical need for pediatric surgical humanitarian care. The role of minimally invasive surgery (MIS) in these environments with its reduction in pain and wound care, operative time, length of hospitalization, and morbidity is logical. However, the costs, logistics and feasibility of MIS in Low- and Middle-Income Countries (LMIC) can be challenging. Our goal was to develop a new low cost rapidly deployable minimally invasive surgical system (RDMIS) for use during remote pediatric general surgical (GPS) missions in LMIC. METHODS: RDMIS system components consist of a universal serial bus (USB) interfaced laparoscopic camera, portable computer and a battery powered wireless portable laparoscopic light source. The surgeon transports the RDMIS in a single standard carry-on luggage. Utilizing prepositioning logistics from prior World Pediatric GPS missions, a standard MIS tower system (sMIS) was maintained on site. RESULTS: The RDMIS was utilized to carry out procedural components of laparoscopic appendicostomy and laparoscopic cholecystectomy. Both sMIS and RDMIS were interchanged during the cases to allow for subjective comparison of surgical exposure and visualization. The RDMIS system allowed for safe and effective visualization and dissection of surgical structures. All children recovered uneventfully and were discharged the following day and have had no complications. The RDMIS system costs were significantly less than those of sMIS. CONCLUSIONS: RDMIS appears to be a safe, inexpensive option that will allow for the translation of modern MIS technology during GPS in remote locations. Further studies validating the RDMIS are indicated, however, the lower costs, ease of transport and potential benefit to children in the LMIC may be significant.

Minimally Invasive Pediatric Surgery During Remote Humanitarian Missions Is Feasible, Safe, and Effective.

PURPOSE: There remains a critical need for the provision for pediatric humanitarian aid worldwide. Historically, the emphasis of global pediatric health needs has been focused on infectious diseases. Today, we are witnessing a shift in this paradigm, with growing attention being paid toward the surgical needs of children. The use and deployment of minimally invasive surgery (MIS) in these austere environments with its concomitant reduction in length of hospitalization, pain, and morbidity is logical. The goal of this study was to report our deployment strategy and review our experience with pediatric MIS during humanitarian missions to determine if it is safe, feasible, and efficacious. METHODS: As part of the World Pediatric Project (WPP), data were collected retrospectively from the general pediatric surgery (GPS) team missions from January 2007 to January 2017. All cases were performed at a single medical center in the Eastern Caribbean Island Nation of St. Vincent and the Grenadines (SVG). Data included patient demographics, diagnosis, procedure, conversion to open procedure, complications, and postoperative course. The teams utilized a dedicated WPP operating theater, prepositioned and deployed GPS supplies, and MIS resources. All anesthesia, surgical, and nursing personal were board certified and trained professionals functioning as part of the WPP team. RESULTS: One hundred thirty-four children underwent general and thoracic pediatric surgical procedures during the study period. Mean age 9.2 years (2-19 years). Thirty-seven children underwent MIS procedures (27%). There were no conversions to open procedures. There were only two postoperative complications, cellulitis following laparoscopic appendicostomies, which required intravenous antibiotics and were discharged on a course of oral antibiotics. The postoperative course for all children was uneventful and no child required readmission. There were no technical failures in the MIS systems or instrumentation. CONCLUSIONS: Our retrospective review supports the use of MIS techniques as part of GPS humanitarian missions. We have found it to be a safe, feasible, and effective modality that may reduce length of stay, pain, and morbidity compared with open procedures in these remote environments. Although our MIS systems and instrumentations functioned effectively, concerns regarding the storage and sustainability for future missions are significant. Onsite health care partners, redundant systems, and remote technical support access could potentially alleviate these concerns.

Evaluación de los resultados del traslado del recién nacido con tratamiento quirúrgico / Evaluation of the Transfer Results of the Newborn with Surgical Treatment

Introducción: el neonato quirúrgico requiere con relativa frecuencia de un traslado especializado hacia los centros que regionalizan su atención específica. Objetivo: evaluar la influencia del traslado en el pronóstico de los recién nacidos quirúrgicos intervenidos en el Centro Regional de Cirugía Neonatal del Hospital Pediátrico Provincial Octavio de la Concepción de la Pedraja de Holguín. Método: se realizó un estudio descriptivo desde enero de 2010 a diciembre de 2012 y se creó un protocolo para perfeccionar el traslado. Resultados: se trasladaron 139 recién nacidos con afecciones quirúrgicas provenientes de las provincias orientales y Holguín; predominó la edad de 1 a 7 días para ambos sexos (56,1 %), de forma general se alcanzó una supervivencia del 87,0 % y una mortalidad en las primeras 48 h del 5,0 %. La provincia que más casos trasladó fue Holguín. No existieron grandes diferencias entre las condiciones clínicas en que se trasladó y en las que se recibió el paciente, sin embargo, los registros de las mismas fueron insuficientes. Respecto a la correlación diagnóstica entre centro emisor y receptor las incongruencias predominaron en las malformaciones complejas del síndrome oclusivo, con diagnóstico incorrecto en 16 pacientes. La causa directa de muerte en la mayoría de los casos fue la sepsis. Conclusiones: los resultados del traslado fueron evaluados de aceptables, aunque el traslado dañino y deficiente influyó en la mortalidad en las primeras 48 horas.

Introduction: the surgical newborn often requires to be sent to specialized centers incharge of this specific care in the region. Objective: to assess the transfer influence on prognosis of neonates undergoing surgery at the Regional Surgical Newborn Center of Octavio de la Concepcion de la Pedraja Pediatric Hospital of Holguin. Method: a descriptive study was done from January 2010 to December 2012 and a protocol was set up to improve the surgical newborns’ movement. Results: one hundred and thirty nine (139) newborns with surgical diseases were sent to the above mentioned center, which were from eastern provinces and from Holguin. The predominant age was from one to seven days of both sexes (56.1 %) and in general the survival achieved was of 87.0 % and 5.0 % of mortality during the first 48 hours. The province which predominated regarding the transfer was Holguin. There were no great differences in clinical conditions between the cases which were transferred to and the ones that received the patients; nevertheless, the records were insufficient. Regarding the diagnostic correlation between the emissor and the receiver center, the irregularities prevailed on the complex malformations of occlusive syndrome, with wrong diagnosis in 16 patients. Sepsis was the direct cause of death in most of cases. Conclusions: the results of transfer were assessed as acceptable, although the harmful and deficient transfer influenced on the mortality in the first 48 hours.

Evaluación de los resultados del traslado del recién nacido con tratamiento quirúrgico / Evaluation of the Transfer Results of the Newborn with Surgical Treatment

Introducción: el neonato quirúrgico requiere con relativa frecuencia de un traslado especializado hacia los centros que regionalizan su atención específica.Objetivo: evaluar la influencia del traslado en el pronóstico de los recién nacidos quirúrgicos intervenidos en el Centro Regional de Cirugía Neonatal del Hospital Pediátrico Provincial Octavio de la Concepción de la Pedraja de Holguín.Método: se realizó un estudio descriptivo desde enero de 2010 a diciembre de 2012 y se creó un protocolo para perfeccionar el traslado.Resultados: se trasladaron 139 recién nacidos con afecciones quirúrgicas provenientes de las provincias orientales y Holguín; predominó la edad de 1 a 7 días para ambos sexos (56,1 por ciento), de forma general se alcanzó una supervivencia del 87,0 por ciento y una mortalidad en las primeras 48 h del 5,0 por ciento. La provincia que más casos trasladó fue Holguín. No existieron grandes diferencias entre las condiciones clínicas en que se trasladó y en las que se recibió el paciente, sin embargo, los registros de las mismas fueron insuficientes. Respecto a la correlación diagnóstica entre centro emisor y receptor las incongruencias predominaron en las malformaciones complejas del síndrome oclusivo, con diagnóstico incorrecto en 16 pacientes. La causa directa de muerte en la mayoría de los casos fue la sepsis.Conclusiones: los resultados del traslado fueron evaluados de aceptables, aunque el traslado dañino y deficiente influyó en la mortalidad en las primeras 48 horas(AU)

Introduction: the surgical newborn often requires to be sent to specialized centers incharge of this specific care in the region.Objective: to assess the transfer influence on prognosis of neonates undergoing surgery at the Regional Surgical Newborn Center of Octavio de la Concepcion de la Pedraja Pediatric Hospital of Holguin.Method: a descriptive study was done from January 2010 to December 2012 and a protocol was set up to improve the surgical newborns movement.Results: one hundred and thirty nine (139) newborns with surgical diseases were sent to the above mentioned center, which were from eastern provinces and from Holguin. The predominant age was from one to seven days of both sexes (56.1 percent) and in general the survival achieved was of 87.0 percent and 5.0 percent of mortality during the first 48 hours. The province which predominated regarding the transfer was Holguin. There were no great differences in clinical conditions between the cases which were transferred to and the ones that received the patients; nevertheless, the records were insufficient. Regarding the diagnostic correlation between the emissor and the receiver center, the irregularities prevailed on the complex malformations of occlusive syndrome, with wrong diagnosis in 16 patients. Sepsis was the direct cause of death in most of cases.Conclusions: the results of transfer were assessed as acceptable, although the harmful and deficient transfer influenced on the mortality in the first 48 hours(AU)