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Current Development of Pediatric Minimally Invasive Surgery (Volume II)
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Current Development of Pediatric Minimally Invasive Surgery (Volume II)

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Surgery".

Deadline for manuscript submissions: 10 January 2025 | Viewed by 13955

Special Issue Editors

Prof. Dr. Robert Bergholz

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Guest Editor
Department of General, Visceral, Thorax, Transplant and Pediatric Surgery, Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
Interests: minimally invasive pediatric surgery; laparoscopy; robotic surgery; fetal surgery; neonatal surgery; endoscopy
Special Issues, Collections and Topics in MDPI journals
Dr. Thomas Franz Krebs

E-Mail Website
Guest Editor
Clinic for Pediatric Surgery, Childrens Hospital of Eastern Switzerland, 9006 Saint Gallen, Switzerland
Interests: MIS; fetal surgery; robotic surgery in childhood
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pediatric minimally invasive surgery (MIS) is a constantly developing field, ranging from fetoscopic procedures in unborn children to robotic-assisted bariatric surgery in overweight adolescents. This wide range of techniques and patients is what makes pediatric MIS exciting and challenging.

Following on from the success of the Special Issue “Current Development of Pediatric Minimally Invasive Surgery” published in Children (https://www.mdpi.com/journal/children/special_issues/Pediatric_Minimally_Invasive_Surgery), we are releasing a second volume of original research papers and review articles focused on the wide spectrum of pediatric minimally invasive surgery. Topics of interest for this volume include well-established procedures, new and visionary ideas, technical developments, perils and pitfalls, controversial procedures, and things we stand to learn from our general, thoracic, and visceral surgical colleagues or the standardized minimally invasive surgical treatment of our young patients.

We do not want just another review of “what has been done so far”; instead, we look to compile reports from inventive colleagues from all medical disciplines who are pushing the frontiers of minimally invasive surgical treatment to the benefit of children.

Prof. Dr. Robert Bergholz
Dr. Thomas Franz Krebs
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • laparoscopy
  • thoracoscopy
  • robotic surgery
  • single incision laparoscopic surgery (SILS)
  • fetal surgery
  • fetoscopy
  • natural orifices transluminal endoscopic surgery (NOTES)
  • endoscopy

Published Papers (9 papers)

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13 pages, 2956 KiB  
Article
Bracing of Pectus Carinatum in Children: Current Practices
by Pavol Omanik, Sergio Bruno Sesia, Katarina Kozlikova, Veronika Schmidtova, Miroslava Funakova and Frank-Martin Haecker
Children 2024, 11(4), 470; https://doi.org/10.3390/children11040470 - 15 Apr 2024
Viewed by 534
Abstract
Background: Although effective, compressive orthotic bracing (COB) in children with pectus carinatum is still not standardized. This study has aimed to analyze current practices amongst members of the Chest Wall International Group (CWIG). Methods: A web-based questionnaire was mailed to all CWIG members [...] Read more.
Background: Although effective, compressive orthotic bracing (COB) in children with pectus carinatum is still not standardized. This study has aimed to analyze current practices amongst members of the Chest Wall International Group (CWIG). Methods: A web-based questionnaire was mailed to all CWIG members at 208 departments. It included 30 questions regarding diagnostic work-up, age for COB indication, type of COB used, daily wearing time, treatment duration, complications, and recurrence rate. Results: Members from 44 departments have responded (institutional response rate 21.2%). A total of 93% consider COB as the first-line treatment for PC. A conventional COB (CC) is used in 59%, and the dynamic compression system (FMF) in 41%. The overall compliance rate is >80%. A total of 67% of responders consider COB to be indicated in patients <10 years. The actual wearing time is significantly shorter than the physician-recommended time (p < 0.01). FMF patients experience a significantly faster response than CC patients (p < 0.01). No recurrence of PC has been noted in 34%; recurrence rates of 10–30% have been noted in 61%. Conclusions: COB is the first-line treatment for PC with a high compliance rate. During puberty, the recurrence rate is high. Treatment standardization and follow-up until the end of puberty are recommended to enhance COB effectiveness. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery (Volume II))
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15 pages, 2477 KiB  
Article
Use of Barbed Sutures for Congenital Diaphragmatic Hernia Repair
by Nadine R. Muensterer, Elena Weigl, Anne-Sophie Holler, Christiane Zeller, Beate Häberle and Oliver J. Muensterer
Children 2024, 11(1), 35; https://doi.org/10.3390/children11010035 - 28 Dec 2023
Viewed by 953
Abstract
Background: Congenital diaphragmatic hernia (CDH) repair can be challenging, particularly when a larger defect is present. Barbed sutures prevent the suture from slipping back after approximation of the tissues. Although introduced almost 2 decades ago, barbed sutures have not been widely used for [...] Read more.
Background: Congenital diaphragmatic hernia (CDH) repair can be challenging, particularly when a larger defect is present. Barbed sutures prevent the suture from slipping back after approximation of the tissues. Although introduced almost 2 decades ago, barbed sutures have not been widely used for CDH repair. We report our initial experience and pitfalls. Methods: All patients presenting with CDH from 2021 onward underwent repair using barbed sutures. Demographics, operative parameters, complications, and outcomes were prospectively recorded. Results: A total of 13 patients underwent CDH repair during the study interval (median age 6 days, range 3 days to 5.75 years). Median operative time was 89 min (range 46 to 288 min). Five thoracoscopic and eight open procedures were performed. Severe pulmonary hypertension and ECMO (extracorporeal membrane oxygenation) were considered contraindications for thoracoscopic repair. The included patients were compared to a historic controlled group performed without barbed sutures. The barbed suture facilitated easy and quick closure of the defects in most cases and obviated the need for knot tying. One patient in the thoracoscopic group had a patch placed due to high tension after the barbed sutures tore the diaphragm. At a median follow-up time of 15 months (range 2 to 34 months), one patient had died, and one patient with complete diaphragmatic agenesis was home-ventilated. There were no recurrences. Median operative time trended lower (89 min) than in the historic control group repaired without barbed sutures (119 min, p < 0.06) after eliminating outliers with large, complex patch repairs. Conclusions: Barbed sutures simplify congenital diaphragmatic hernia repair regardless of whether a minimal-invasive or open approach is performed. Patch repair is not a contraindication for using barbed sutures. The resulting potential time savings make them particularly useful in patients with cardiac or other severe co-morbidities in which shorter operative times are essential. In cases with high tension, though, the barbs may tear through and produce a “saw” effect on the tissue with subsequent damage. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery (Volume II))
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7 pages, 1869 KiB  
Communication
Intraoperative Ultrasound in Minimally Invasive Laparoscopic and Robotic Pediatric Surgery: Our Experiences and Literature Review
by Marco Di Mitri, Eduje Thomas, Annalisa Di Carmine, Ilaria Manghi, Sara Maria Cravano, Cristian Bisanti, Edoardo Collautti, Francesca Ruspi, Chiara Cordola, Marzia Vastano, Simone D’Antonio, Michele Libri, Tommaso Gargano and Mario Lima
Children 2023, 10(7), 1153; https://doi.org/10.3390/children10071153 - 30 Jun 2023
Cited by 1 | Viewed by 1148
Abstract
Ultrasound (US) is a non-invasive imaging technique frequently used to examine internal organs and superficial tissues, and invaluable in pediatric patients. In a surgical setting, intraoperative ultrasound allows to highlight anatomical structures in detail during traditional open and minimally invasive surgery, thanks to [...] Read more.
Ultrasound (US) is a non-invasive imaging technique frequently used to examine internal organs and superficial tissues, and invaluable in pediatric patients. In a surgical setting, intraoperative ultrasound allows to highlight anatomical structures in detail during traditional open and minimally invasive surgery, thanks to the use of specific probes. In fact, laparoscopic and robotic ultrasonography requires the development of specialized transducers that fit through laparoscopic trocars. In adults, laparoscopic ultrasound is used during cholecystectomy before dissection of the triangle of Calot, to guide liver biopsies and ablation procedures and for the staging of patients with pancreas adenocarcinoma. However, the applications in the pediatric field are still limited. This paper aims to share our preliminary experience with ultra-sound in minimally invasive laparoscopic and robotic pediatric surgery, describing two cases in which intra-operative ultrasound was applied, and to present a review of the literature on the state of the art of the actual uses in pediatric surgery. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery (Volume II))
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13 pages, 1286 KiB  
Article
Mobile Dressing Trolleys Improve Satisfaction and Logistics on Pediatric Surgery Wards
by Hannes Franck, Astrid Dempfle, Katja Reischig, Jonas Baastrup, Andreas Meinzer, Meike Kossakowski, Thomas Franz Krebs and Robert Bergholz
Children 2023, 10(7), 1089; https://doi.org/10.3390/children10071089 - 21 Jun 2023
Viewed by 1022
Abstract
Background: Evidence-based data on the effect of dressing trolleys on children’s postoperative recovery are not available. The aim of this study was to evaluate a specific pediatric surgical dressing trolley on patient and caregiver satisfaction, as well as temporal and logistical aspects of [...] Read more.
Background: Evidence-based data on the effect of dressing trolleys on children’s postoperative recovery are not available. The aim of this study was to evaluate a specific pediatric surgical dressing trolley on patient and caregiver satisfaction, as well as temporal and logistical aspects of the dressing change procedures. Methods: In a prospective observational non-randomized study, a total of 100 dressing changes were observed before (group 1) and after (group 2) the introduction of a pediatric surgical dressing trolley and the satisfaction, time and logistical factors were recorded on site. Results: The median preparation time, the duration of the dressing change and the total time decreased significantly from group 1 to group 2 by 1:11 min (p < 0.001); 1:56 min (p = 0.05) and 5:09 min (p = 0.001), respectively. The patient’s room was left significantly less often in group 2 to retrieve missing bandages. The median satisfaction of the medical staff increased by 12% in group 2 (p < 0.001). The satisfaction of the parents increased by 2.5% in group 2 (p = 0.042), and that of the nursing staff increased by 9.25% in group 2 (p = 0.015). Conclusions: Our results demonstrate the positive effects of a dressing trolley for pediatric surgical dressing changes by minimizing postoperative handling and manipulation of the child. It improves time and logistical factors as well as the satisfaction of those involved, which may lead to a faster recovery. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery (Volume II))
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14 pages, 6856 KiB  
Article
Evaluation of the Versius Robotic System for Infant Surgery—A Study in Piglets of Less than 10 kg Body Weight
by Thomas Franz Krebs, Timo Kayser, Ulf Lorenzen, Matthias Grünewald, Marit Kayser, Anna Saltner, Lidya-Olgu Durmaz, Lina Johanna Reese, Ewan Brownlee, Katja Reischig, Jonas Baastrup, Andreas Meinzer, Almut Kalz, Thomas Becker and Robert Bergholz
Children 2023, 10(5), 831; https://doi.org/10.3390/children10050831 - 03 May 2023
Cited by 1 | Viewed by 1515
Abstract
Background: We were able to demonstrate the feasibility of a new robotic system (Versius, CMR Surgical, Cambridge, UK) for procedures in small inanimate cavities. The aim of this consecutive study was to test the Versius® system for its feasibility, performance, and safety [...] Read more.
Background: We were able to demonstrate the feasibility of a new robotic system (Versius, CMR Surgical, Cambridge, UK) for procedures in small inanimate cavities. The aim of this consecutive study was to test the Versius® system for its feasibility, performance, and safety of robotic abdominal and thoracic surgery in piglets simulating infants with a body weight lower than 10 kg. Methods: A total of 24 procedures (from explorative laparoscopy to thoracoscopic esophageal repair) were performed in 4 piglets with a mean age of 12 days and a mean body weight of 6.4 (7–7.5) kg. Additional urological procedures were performed after euthanasia of the piglet. The Versius® robotic system was used with 5 mm wristed instruments and a 10 mm 3D 0° or 30° camera. The setup consisted of the master console and three to four separate arms. The performance of the procedure, the size, position, and the distance between the ports, the external and internal collisions, and complications of the procedures were recorded and analyzed. Results: We were able to perform all surgical procedures as planned. We encountered neither surgical nor robot-associated complications in the live model. Whereas all abdominal procedures could be performed successfully under general anesthesia, one piglet was euthanized early before the thoracic interventions, likely due to pulmonary inflammatory response. Technical limitations were based on the size of the camera (10 mm) being too large and the minimal insertion depth of the instruments for calibration of the fulcrum point. Conclusions: Robotic surgery on newborns and infants appears technically feasible with the Versius® system. Software adjustments for fulcrum point calibration need to be implemented by the manufacturer as a result of our study. To further evaluate the Versius® system, prospective trials are needed, comparing it to open and laparoscopic surgery as well as to other robotic systems. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery (Volume II))
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9 pages, 829 KiB  
Article
Thoracoscopic Resection of Lung Nodules following CT-Guided Labeling in Children and Adolescents with Solid Tumors
by Steven W. Warmann, Justus Lieber, Juergen F. Schaefer, Martin Ebinger, Cristian Urla, Hans-Joachim Kirschner, Ilias Tsiflikas, Andreas Schmidt and Joerg Fuchs
Children 2023, 10(3), 542; https://doi.org/10.3390/children10030542 - 12 Mar 2023
Viewed by 2097
Abstract
Resection of lung metastases in children with solid tumors is regularly hampered by limited intraoperative detectability and relevant operative trauma of the open surgical access. The aim of this study was to analyze thoracoscopic resection of lung metastases in children following CT-guided labeling [...] Read more.
Resection of lung metastases in children with solid tumors is regularly hampered by limited intraoperative detectability and relevant operative trauma of the open surgical access. The aim of this study was to analyze thoracoscopic resection of lung metastases in children following CT-guided labeling with coil wires. We retrospectively analyzed data of children and adolescents undergoing this approach at our institution between 2010 and 2022 with regard to technical aspects as well as surgical and oncological data. Within this period, we performed this procedure on 12 patients wherein we resected 18 lesions (1–5 per patient). The median age of patients was 178 months (51–265). The median duration of coil wire placement was 41 min (30–173) and the median surgery time was 53 min (11–157). No conversions were necessary and no intraoperative complications occurred. Complete microscopic resection (R0) was achieved in all labeled lesions and malignant tumor components were found in 5/12 patients. Our study shows that with a careful patient selection, thoracoscopic resection of lung metastases after coil wire labeling is a safe and reproducible procedure in children. Using this approach, lesions that are expected to have a reduced intraoperative detectability during open surgery become resectable. Patients benefit from the minimally invasive surgical access and reduced operative trauma. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery (Volume II))
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10 pages, 92928 KiB  
Case Report
Less-Invasive Approach to Early-Onset Scoliosis—Surgical Technique for Magnetically Controlled Growing Rod (MCGR) Based on Treatment of 2-Year-Old Child with Severe Scoliosis
by Pawel Grabala, Ilkka J. Helenius, Kelly Chamberlin and Michael Galgano
Children 2023, 10(3), 555; https://doi.org/10.3390/children10030555 - 15 Mar 2023
Cited by 3 | Viewed by 2051
Abstract
Background: Spinal deformities in children can be caused by various etiologies, such as congenital, syndromic, neuromuscular, or idiopathic. Early-onset scoliosis (EOS) is diagnosed before the age of ten years, and when the curvature continues to progress and exceeds a Cobb angle of 60–65 [...] Read more.
Background: Spinal deformities in children can be caused by various etiologies, such as congenital, syndromic, neuromuscular, or idiopathic. Early-onset scoliosis (EOS) is diagnosed before the age of ten years, and when the curvature continues to progress and exceeds a Cobb angle of 60–65 degrees, surgical treatment should be considered. Initial minimally invasive surgery and the implantation of magnetically controlled growing rods (MCGRs) allows for the noninvasive distraction of the spine, growing, and avoids multiple operations associated with the classic distractions of standard growing rods. Case presentation: A 2-year-old girl was admitted to our clinic with rapidly progressive thoracic scoliosis. The major curve of the thoracic spine Cobb angle was 122° at 30 months. No congenital deformities were detected. The surgical technique was the less-invasive percutaneous and subfascial implantation of MCGRs, without long incisions on the back and the non-invasive ambulatory lengthening of her spine over the next 4 years. Conclusions: MCGR is a safe procedure for EOS patients. It is extremely effective at correcting spinal deformity; controlling the growth and curvature of the spine as the child develops during growth; reducing the number of hospitalizations and anesthesia; and minimizing the physical and mental burden of young patients, parents, and their families. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery (Volume II))
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8 pages, 1476 KiB  
Case Report
Localization and Laparoscopic Excision of Gastric Heterotopic Pancreas in a Child by Endoscopic SPOT® Tattooing
by Yu-Jung Liou, Shu-Chao Weng, Paul Chia-Yu Chang, Chuen-Bin Jiang, Hung-Chang Lee, Wai-Tao Chan, Cheng-Yu Ho, Pao-Shu Wu and Chun-Yan Yeung
Children 2023, 10(2), 201; https://doi.org/10.3390/children10020201 - 22 Jan 2023
Cited by 1 | Viewed by 1519
Abstract
Heterotopic pancreas (HP) is defined as pancreatic tissue lacking vascular or anatomic connection with the normal pancreas. Surgical resection is often indicated for symptomatic gastric HP. However, intraoperative identification of gastric HP is often difficult during laparoscopic surgery. Herein, we describe a patient [...] Read more.
Heterotopic pancreas (HP) is defined as pancreatic tissue lacking vascular or anatomic connection with the normal pancreas. Surgical resection is often indicated for symptomatic gastric HP. However, intraoperative identification of gastric HP is often difficult during laparoscopic surgery. Herein, we describe a patient with gastric HP, which was marked with SPOT® dye (GI Supply, Camp Hill, PA, USA). The dye was seen clearly laparoscopically facilitating total excision of the lesion. The final pathology report confirmed the presence of heterotopic pancreatic tissue including pancreatic acini, small pancreatic ducts tissue with islets of Langerhans in the deep gastric submucosal area. There were no postoperative complications, and the patient was symptom-free. To the best of our knowledge, this was the first case report in the literature in which endoscopic tattooing of gastric HP before laparoscopic resection was performed. This method of localization was simple and reliable in children. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery (Volume II))
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10 pages, 1258 KiB  
Case Report
Senhance Robotic Platform in Pediatrics: Early US Experience
by Maria Consuelo Puentes, Marko Rojnica, Thomas Sims, Robert Jones, Francesco M. Bianco and Thom E. Lobe
Children 2023, 10(2), 178; https://doi.org/10.3390/children10020178 - 18 Jan 2023
Cited by 2 | Viewed by 2288
Abstract
Introduction: Different robotic systems have been used widely in human surgery since 2000, but pediatric patients require some features that are lacking in the most frequently used robotic systems. Hypothesis: The Senhance® robotic system is a safe and an effective device for [...] Read more.
Introduction: Different robotic systems have been used widely in human surgery since 2000, but pediatric patients require some features that are lacking in the most frequently used robotic systems. Hypothesis: The Senhance® robotic system is a safe and an effective device for use in infants and children that has some advantages over other robotic systems. Methods: All patients between 0 and 18 years of age whose surgery was amenable to laparoscopy were offered enrollment in this IRB-approved study. We assessed the feasibility, ease and safety of using this robotic platform in pediatric patients including: set-up time, operative time, conversions, complications and outcomes. Results: Eight patients, ranging from 4 months to 17 years of age and weighing between 8 and 130 kg underwent a variety of procedures including: cholecystectomy (3), inguinal herniorrhaphy (3), orchidopexy for undescended testes (1) and exploration for a suspected enteric duplication cyst (1). All robotic procedures were successfully performed. The 4-month-old (mo), 8 kg patient underwent an uneventful robotic exploration in an attempt to locate a cyst that was hidden in the mesentery at the junction of the terminal ileum and cecum, but ultimately the patient required an anticipated laparotomy to palpate the cyst definitively and to excise it completely. There was no blood loss and no complications. Robotic manipulation with the reusable 3 mm instruments proved successful in all cases. Conclusions: Our initial experience with the Senhance® robotic platform suggests that this is a safe and effective device for pediatric surgery that is easy to use, and which warrants continued evaluation. Most importantly, there appears to be no lower age or weight restrictions to its use. Full article
(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery (Volume II))
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