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Pediatric surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Laparoscopic treatment of a hydatid cyst of the liver in children
Introduction:
Hydatid cyst is a parasitic disease caused by the Echinococcus granulosus tapeworm. Laparoscopic treatment of a hydatid cyst of the liver remains controversial and few series have been published. The aim of this work is to present a case of liver hydatid cyst in an 8-year-old girl treated laparoscopically.
Case presentation:
An 8-year-old child was admitted to our department for the management of a voluminous liver hydatid cyst. The patient underwent a thoraco-abdominal CT-scan, which concluded to a left lobe liver hydatid cyst. The laparoscopic open access is achieved at the umbilicus using a 10mm port. Carbon dioxide pneumoperitoneum pressure is maintained at 10mmHg. Two other 5mm ports are introduced in the right and left hypochondrium. A 0-degree laparoscope is then used. The cyst is protected by means of pads filled with a 10% hypertonic saline solution. After we proceed to a puncture aspiration of the cyst, sterilization is achieved via injection of a hypertonic saline solution during 15 minutes, then reaspiration is performed with a Veress needle. The cyst is opened with a coagulating hook and the proligerous membrane is removed and put in a bag. The last step is the resection of the dome and the search for biliary fistula. We drained the residual cavity. The pads are removed. The Redon drain was removed on day 2 and the patient was discharged from hospital on postoperative day 3. Postoperatively, the patient was put on albendazole (10mg/kg) for one month.
Conclusion:
Laparoscopy stands for an excellent approach to the treatment of a hydatid cyst of the liver in children by respecting appropriate indications.
R Adjerid, F Sebaa, N Otsmane, A Khelifaoui
Surgical intervention
2 months ago
1153 views
4 likes
4 comments
05:13
Laparoscopic treatment of a hydatid cyst of the liver in children
Introduction:
Hydatid cyst is a parasitic disease caused by the Echinococcus granulosus tapeworm. Laparoscopic treatment of a hydatid cyst of the liver remains controversial and few series have been published. The aim of this work is to present a case of liver hydatid cyst in an 8-year-old girl treated laparoscopically.
Case presentation:
An 8-year-old child was admitted to our department for the management of a voluminous liver hydatid cyst. The patient underwent a thoraco-abdominal CT-scan, which concluded to a left lobe liver hydatid cyst. The laparoscopic open access is achieved at the umbilicus using a 10mm port. Carbon dioxide pneumoperitoneum pressure is maintained at 10mmHg. Two other 5mm ports are introduced in the right and left hypochondrium. A 0-degree laparoscope is then used. The cyst is protected by means of pads filled with a 10% hypertonic saline solution. After we proceed to a puncture aspiration of the cyst, sterilization is achieved via injection of a hypertonic saline solution during 15 minutes, then reaspiration is performed with a Veress needle. The cyst is opened with a coagulating hook and the proligerous membrane is removed and put in a bag. The last step is the resection of the dome and the search for biliary fistula. We drained the residual cavity. The pads are removed. The Redon drain was removed on day 2 and the patient was discharged from hospital on postoperative day 3. Postoperatively, the patient was put on albendazole (10mg/kg) for one month.
Conclusion:
Laparoscopy stands for an excellent approach to the treatment of a hydatid cyst of the liver in children by respecting appropriate indications.
Laparoscopic repair of a congenital diaphragmatic hernia (CDH)
Eligibility criteria for the thoracoscopic approach in case of a congenital diaphragmatic hernia (CDH) in infants were jointly addressed at the ESPES/IPEG-ESPU Masterclass in March 2017 held at IRCAD, and also published on WeBSurg.
This video aims to show a series of technical details in case of thoracoscopy for CDH grade B according to the currently accepted international classification. At the beginning of the procedure, short intrathoracic low pressure carbon dioxide insufflation at 4mmHg and 1.5 Liter per minute was performed during hernia reduction. The posterior diaphragmatic border was then freed and a diaphragmatic suture was performed using non-absorbable separate 2/0 stitches. A GoreTex DualMesh® patch was used to complete the external suturing of the diaphragm and to achieve fixation stitches.
I Kauffmann, F Becmeur
Surgical intervention
8 months ago
2413 views
12 likes
4 comments
04:17
Laparoscopic repair of a congenital diaphragmatic hernia (CDH)
Eligibility criteria for the thoracoscopic approach in case of a congenital diaphragmatic hernia (CDH) in infants were jointly addressed at the ESPES/IPEG-ESPU Masterclass in March 2017 held at IRCAD, and also published on WeBSurg.
This video aims to show a series of technical details in case of thoracoscopy for CDH grade B according to the currently accepted international classification. At the beginning of the procedure, short intrathoracic low pressure carbon dioxide insufflation at 4mmHg and 1.5 Liter per minute was performed during hernia reduction. The posterior diaphragmatic border was then freed and a diaphragmatic suture was performed using non-absorbable separate 2/0 stitches. A GoreTex DualMesh® patch was used to complete the external suturing of the diaphragm and to achieve fixation stitches.
Inanimate model to train for the thoracoscopic repair of all varieties of left congenital diaphragmatic hernia (CDH)
We present a new low-cost model designed for training skills and strategies for the thoracoscopic repair of left congenital diaphragmatic defects. We will present guidelines to make this type of models, the educational strategy that we use in our advanced training models, the defects that can be trained, and the scope of this model. Advanced training, learning tips and tricks from experts, and the use of innovative ideas from other authors used in our model are outlined. This educational tool was developed for pediatric surgeons requiring advanced training. It reinforces the concept of advanced and continuous training, in a safe environment, and it is assisted by experienced surgeons. This model shows a scenario where dimensions and anatomical repairs are carefully preserved.
We share our vision of continuous endosurgical education to encourage all enthusiastic surgeons to train in safe and controlled environments.
Materials and methods: The model consists in a plastic 3D printed left rib cage, extracted from a 6-month-old baby CT-scan combined with simulated mediastinal structures, diaphragm, bowel, lung, and spleen made of latex, silicone, and polyester sponge respectively. A self-adhesive film is used as parietal pleura. A removable part (spare part) represents the last three ribs where the diaphragm is partially inserted, and a base as the upper abdomen is assembled to the left rib cage (ribs 1 to 9). Abdominal viscera (plastic or animal) are placed in this base. The cost of materials is 150 US$.
The model is meant to simulate the most frequent diaphragmatic defects such as type A, B, and C, with or without sac. However, other rare defects can also be simulated. Live animal tissues such as diaphragm or intestine also can be used, as it was already published by other authors. However, the main characteristic of this model is to be inanimate, portable, and easily reloadable to be reused.
The video shows a junior surgeon in his advanced training process. In the model, we perform the reduction of the viscera slid to the thorax. In this case, it is the rabbit intestine, but we usually use latex simulated intestine. The spleen is completely synthetic and bleeds if the instruments damage it during the reduction.
We use 3mm regular instruments. The repair of the defect is made with separate stitches of 2/0 or 3/0 braided polyester as usual, and we encourage trainees to practice the intracorporeal sliding knot and running suture. We collect the performance data in a specially prepared form and carry out the debriefing.
Conclusions: With this model, we can reinforce the concept of low cost, but with a high precision environment simulation, included within a standardized training program in minimally invasive neonatal surgery. We believe that it is a very useful tool. In addition, this type of models allows the use of new surgical techniques, tips and tricks given by experienced surgeons who assist in the training process.
M Maricic, M Bailez
Surgical intervention
8 months ago
1299 views
5 likes
1 comment
08:14
Inanimate model to train for the thoracoscopic repair of all varieties of left congenital diaphragmatic hernia (CDH)
We present a new low-cost model designed for training skills and strategies for the thoracoscopic repair of left congenital diaphragmatic defects. We will present guidelines to make this type of models, the educational strategy that we use in our advanced training models, the defects that can be trained, and the scope of this model. Advanced training, learning tips and tricks from experts, and the use of innovative ideas from other authors used in our model are outlined. This educational tool was developed for pediatric surgeons requiring advanced training. It reinforces the concept of advanced and continuous training, in a safe environment, and it is assisted by experienced surgeons. This model shows a scenario where dimensions and anatomical repairs are carefully preserved.
We share our vision of continuous endosurgical education to encourage all enthusiastic surgeons to train in safe and controlled environments.
Materials and methods: The model consists in a plastic 3D printed left rib cage, extracted from a 6-month-old baby CT-scan combined with simulated mediastinal structures, diaphragm, bowel, lung, and spleen made of latex, silicone, and polyester sponge respectively. A self-adhesive film is used as parietal pleura. A removable part (spare part) represents the last three ribs where the diaphragm is partially inserted, and a base as the upper abdomen is assembled to the left rib cage (ribs 1 to 9). Abdominal viscera (plastic or animal) are placed in this base. The cost of materials is 150 US$.
The model is meant to simulate the most frequent diaphragmatic defects such as type A, B, and C, with or without sac. However, other rare defects can also be simulated. Live animal tissues such as diaphragm or intestine also can be used, as it was already published by other authors. However, the main characteristic of this model is to be inanimate, portable, and easily reloadable to be reused.
The video shows a junior surgeon in his advanced training process. In the model, we perform the reduction of the viscera slid to the thorax. In this case, it is the rabbit intestine, but we usually use latex simulated intestine. The spleen is completely synthetic and bleeds if the instruments damage it during the reduction.
We use 3mm regular instruments. The repair of the defect is made with separate stitches of 2/0 or 3/0 braided polyester as usual, and we encourage trainees to practice the intracorporeal sliding knot and running suture. We collect the performance data in a specially prepared form and carry out the debriefing.
Conclusions: With this model, we can reinforce the concept of low cost, but with a high precision environment simulation, included within a standardized training program in minimally invasive neonatal surgery. We believe that it is a very useful tool. In addition, this type of models allows the use of new surgical techniques, tips and tricks given by experienced surgeons who assist in the training process.
Thoracoscopic repair of pure esophageal atresia
A full-term baby weighing 2.8 kg was diagnosed with pure esophageal atresia. No other associated anomalies were found by abdominal sonography and echocardiography. The primary anastomosis was completed thoracoscopically after mobilization of both esophageal pouches. The patient was placed in a prone position at the edge of the operating table. A 5mm, 30-degree angled scope was introduced one fingerbreadth below the lower angle of the scapula. Two 3mm working ports were also inserted; the first in the same costal space as the camera port 3cm from the middle line and the second as high as possible in the axilla. A thin fibrous strand was found connecting both ends of the esophagus. The azygos vein was left intact. Blunt dissection was used throughout the whole procedure to preserve the aortic branches to the lower pouch, dissecting in between them. Without traction, the distance between both pouches was approximately 4cm or 4 vertebral bodies. No tracheoesophageal fistula (TEF) was identified. Nine polyglactin 5/0 sliding tumble square knots were used to complete the anastomosis. The operative time was 85 minutes. The postoperative period was uneventful. Nasogatric tube feeding started on postoperative day 2, and the patient was discharged on postoperative day 6 after performing a contrast swallow test ensuring that there is no leakage.
MM Elbarbary, KHK Bahaaeldin, AE Fares, H Seleim, A Shalaby, M Elseoudi, MM Ragab
Surgical intervention
1 year ago
1911 views
231 likes
0 comments
18:13
Thoracoscopic repair of pure esophageal atresia
A full-term baby weighing 2.8 kg was diagnosed with pure esophageal atresia. No other associated anomalies were found by abdominal sonography and echocardiography. The primary anastomosis was completed thoracoscopically after mobilization of both esophageal pouches. The patient was placed in a prone position at the edge of the operating table. A 5mm, 30-degree angled scope was introduced one fingerbreadth below the lower angle of the scapula. Two 3mm working ports were also inserted; the first in the same costal space as the camera port 3cm from the middle line and the second as high as possible in the axilla. A thin fibrous strand was found connecting both ends of the esophagus. The azygos vein was left intact. Blunt dissection was used throughout the whole procedure to preserve the aortic branches to the lower pouch, dissecting in between them. Without traction, the distance between both pouches was approximately 4cm or 4 vertebral bodies. No tracheoesophageal fistula (TEF) was identified. Nine polyglactin 5/0 sliding tumble square knots were used to complete the anastomosis. The operative time was 85 minutes. The postoperative period was uneventful. Nasogatric tube feeding started on postoperative day 2, and the patient was discharged on postoperative day 6 after performing a contrast swallow test ensuring that there is no leakage.
Laparoscopic Ladd’s procedure for intestinal malrotation in an 18-month-old boy
Performing Ladd’s procedure for intestinal malrotation using a laparoscopic approach can be confusing and challenging. This can be attributed to the small working space in children as compared to the length of small and large bowel to be handled. The procedure also requires some understanding of the overall anatomical disorder in order to separate it into smaller steps of correction. The first step is to confirm the diagnosis. The operator has to identify the ligament of Treitz and the presence of Ladd’s bands stretching between the colon and the right abdomen. The bands are divided first to the left of the duodenum, and then between the duodenum and the colon. As a result, the mesentery is widened. Bowel derotation is then started placing the small bowel in the right side and the colon in the left side of the abdomen. The procedure is concluded with an appendectomy.
TA Wafa, S Abdelmaksoud
Surgical intervention
1 year ago
845 views
140 likes
0 comments
06:00
Laparoscopic Ladd’s procedure for intestinal malrotation in an 18-month-old boy
Performing Ladd’s procedure for intestinal malrotation using a laparoscopic approach can be confusing and challenging. This can be attributed to the small working space in children as compared to the length of small and large bowel to be handled. The procedure also requires some understanding of the overall anatomical disorder in order to separate it into smaller steps of correction. The first step is to confirm the diagnosis. The operator has to identify the ligament of Treitz and the presence of Ladd’s bands stretching between the colon and the right abdomen. The bands are divided first to the left of the duodenum, and then between the duodenum and the colon. As a result, the mesentery is widened. Bowel derotation is then started placing the small bowel in the right side and the colon in the left side of the abdomen. The procedure is concluded with an appendectomy.
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.
S Holland-Cunz
Surgical intervention
1 year ago
1839 views
206 likes
0 comments
03:54
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.
Laparoscopic choledochal cyst excision with intraoperative cholangiogram, hepatic duct cholangioscopy, extracorporeal Roux-en-Y hepaticojejunostomy and closure of mesenteric defects
The laparoscopic treatment of a choledochal cyst begins with a careful preoperative understanding of the anatomy, including bile ducts, as well as the presence of any abnormal pancreatobiliary anatomy. If a hepaticojejunostomy using a Roux-en-Y anastomosis is performed, we prefer an extracorporeal, transumbilical anastomosis, with a retrocolic approach. A series of interrupted or continuous absorbable sutures can be used for the bilioenteric anastomosis. For the last part of the procedure, we emphasize the importance of closure of mesenteric defects with non-absorbable sutures, including both the retrocolic space and Petersen’s defect to prevent future internal herniations.
GA Villalona, D Ozgediz
Surgical intervention
2 years ago
1596 views
73 likes
0 comments
10:31
Laparoscopic choledochal cyst excision with intraoperative cholangiogram, hepatic duct cholangioscopy, extracorporeal Roux-en-Y hepaticojejunostomy and closure of mesenteric defects
The laparoscopic treatment of a choledochal cyst begins with a careful preoperative understanding of the anatomy, including bile ducts, as well as the presence of any abnormal pancreatobiliary anatomy. If a hepaticojejunostomy using a Roux-en-Y anastomosis is performed, we prefer an extracorporeal, transumbilical anastomosis, with a retrocolic approach. A series of interrupted or continuous absorbable sutures can be used for the bilioenteric anastomosis. For the last part of the procedure, we emphasize the importance of closure of mesenteric defects with non-absorbable sutures, including both the retrocolic space and Petersen’s defect to prevent future internal herniations.
Laparoscopic enucleation of a cystic tumor of the pancreas in a child
This short video describes the laparoscopic enucleation of a benign congenital excretory cyst of the pancreas in a 13-year-old girl.
No prenatal diagnosis had been envisaged and this teen girl was admitted in an emergency setting, with iterative abdominal pain followed by vomiting and weight loss (3Kg) over the last two months.
The entire work-up allowed to rule out the presence of parenchymal tumor involvement and the perfectly regular isolated and apparently normal nature of a cyst situated on the posterior aspect of the pancreatic head, which is totally separate from the biliary tract and from the duodenum.
In these conditions, the diagnosis of Frantz tumor was ruled out and the most probable hypothesis was that of a congenital cystic pancreatic tumor which had recently increased in size. The specificity of the technique used consisted in a pancreatic detachment using a Kocher’s maneuver. The posterior aspect of the pancreatic head was then detached in order to "plicate" or fold the pancreas upon itself.
Once turned over 180 degrees to the left, the posterior aspect of the pancreatic head was perfectly exposed. In addition, after puncture of the cyst, the clear fluid content of the cyst was replaced by a blue dye in order to perfectly identify it through a thin layer of pancreatic parenchyma.
The cyst’s enucleation was subsequently facilitated. No adhesion impaired its detachment from the remainder of the pancreatic tissue. Since the pericystic area was preserved, the risk of secondary pancreatic fistula was prevented, especially because the cyst had been previously opacified, which allowed to rule out any potential communication with the excretory ducts of the pancreas.
I Kauffmann, F Becmeur
Surgical intervention
2 years ago
622 views
13 likes
0 comments
02:59
Laparoscopic enucleation of a cystic tumor of the pancreas in a child
This short video describes the laparoscopic enucleation of a benign congenital excretory cyst of the pancreas in a 13-year-old girl.
No prenatal diagnosis had been envisaged and this teen girl was admitted in an emergency setting, with iterative abdominal pain followed by vomiting and weight loss (3Kg) over the last two months.
The entire work-up allowed to rule out the presence of parenchymal tumor involvement and the perfectly regular isolated and apparently normal nature of a cyst situated on the posterior aspect of the pancreatic head, which is totally separate from the biliary tract and from the duodenum.
In these conditions, the diagnosis of Frantz tumor was ruled out and the most probable hypothesis was that of a congenital cystic pancreatic tumor which had recently increased in size. The specificity of the technique used consisted in a pancreatic detachment using a Kocher’s maneuver. The posterior aspect of the pancreatic head was then detached in order to "plicate" or fold the pancreas upon itself.
Once turned over 180 degrees to the left, the posterior aspect of the pancreatic head was perfectly exposed. In addition, after puncture of the cyst, the clear fluid content of the cyst was replaced by a blue dye in order to perfectly identify it through a thin layer of pancreatic parenchyma.
The cyst’s enucleation was subsequently facilitated. No adhesion impaired its detachment from the remainder of the pancreatic tissue. Since the pericystic area was preserved, the risk of secondary pancreatic fistula was prevented, especially because the cyst had been previously opacified, which allowed to rule out any potential communication with the excretory ducts of the pancreas.
Laparoscopic management of a catecholamine-secreting paraganglioma in a 15-year-old boy
We report the case of the surgical removal of a paravesical paraganglioma located on the right vesicoureteric junction in a 15-year-old boy who was screened positive for SDHB gene mutation, which his father suffers from. Indeed, his dad died of a metastatic paraganglioma, notably including bone and cerebral metastases.
The patient has been complaining of major headaches for some time, which were triggered off during urination to the point that he held in urine as long as possible during daytime in order to avoid urinating, and this seemed to be immediately related to the onset of severe headaches.
The tumor location allowed to correctly understand the phenomenon intraoperatively since every bladder mobilization would induce abrupt bouts of high blood pressure.
Resting blood pressure did not evidence any particular anomaly. However, there were high fluctuations in blood pressure, notably when headaches were reported. The tumor was located exactly at the vesicoureteric junction. It necessitated the resection of the lower ureter and the placement of a vesical patch.
Complete surgical resection allowed to eliminate all symptoms. The patient’s clinical and biological work-up is strictly normal more than one year after the intervention.
The resection was performed without paying attention to the potential difficulties related to the type of reconstructive surgery which entailed. Reconstruction of the vesicoureteric junction was achieved without any major problem on a slightly reduced bladder. A minimal vesicoureteric reimplantation was performed according to the Lich-Gregoir technique, with bladder closure onto a vesical drain and a vesicoureteric double J catheter.
Immediate outcomes were uneventful and control performed more than one year postoperatively testified to the absence of tumor recurrence and to the very good functioning of the vesicoureteric junction.
F Becmeur, S Soskin
Surgical intervention
2 years ago
405 views
16 likes
0 comments
04:08
Laparoscopic management of a catecholamine-secreting paraganglioma in a 15-year-old boy
We report the case of the surgical removal of a paravesical paraganglioma located on the right vesicoureteric junction in a 15-year-old boy who was screened positive for SDHB gene mutation, which his father suffers from. Indeed, his dad died of a metastatic paraganglioma, notably including bone and cerebral metastases.
The patient has been complaining of major headaches for some time, which were triggered off during urination to the point that he held in urine as long as possible during daytime in order to avoid urinating, and this seemed to be immediately related to the onset of severe headaches.
The tumor location allowed to correctly understand the phenomenon intraoperatively since every bladder mobilization would induce abrupt bouts of high blood pressure.
Resting blood pressure did not evidence any particular anomaly. However, there were high fluctuations in blood pressure, notably when headaches were reported. The tumor was located exactly at the vesicoureteric junction. It necessitated the resection of the lower ureter and the placement of a vesical patch.
Complete surgical resection allowed to eliminate all symptoms. The patient’s clinical and biological work-up is strictly normal more than one year after the intervention.
The resection was performed without paying attention to the potential difficulties related to the type of reconstructive surgery which entailed. Reconstruction of the vesicoureteric junction was achieved without any major problem on a slightly reduced bladder. A minimal vesicoureteric reimplantation was performed according to the Lich-Gregoir technique, with bladder closure onto a vesical drain and a vesicoureteric double J catheter.
Immediate outcomes were uneventful and control performed more than one year postoperatively testified to the absence of tumor recurrence and to the very good functioning of the vesicoureteric junction.
Laparoscopic pylorus-preserving pancreaticoduodenectomy for Gruber-Frantz tumor
This video demonstrates our technique for laparoscopic pylorus-preserving pancreaticoduodenectomy performed in a 15-year-old girl presenting with a history of episodic mild abdominal colic pain and right upper quadrant mass.
The preoperative diagnosis of a solid pseudo-papillary tumor (Gruber-Frantz tumor) was made, based on ultrasonography and computed tomography.
Laparoscopic resection was decided upon based on the fact that there were clearly defined surgical planes despite of the size of the mass. The usual sequence of steps for a pancreaticoduodenectomy was altered in this particular case because of tumor dimensions.
The procedure was carried out in 438 minutes without complications. There were no symptoms of delayed gastric emptying, and the patient was discharged on postoperative day 5. The microscopic study of the tumor confirmed a 10.5 by 9 by 5.5cm solid pseudo-papillary tumor of the pancreatic head.
JM Cabada Lee
Surgical intervention
2 years ago
755 views
24 likes
0 comments
09:00
Laparoscopic pylorus-preserving pancreaticoduodenectomy for Gruber-Frantz tumor
This video demonstrates our technique for laparoscopic pylorus-preserving pancreaticoduodenectomy performed in a 15-year-old girl presenting with a history of episodic mild abdominal colic pain and right upper quadrant mass.
The preoperative diagnosis of a solid pseudo-papillary tumor (Gruber-Frantz tumor) was made, based on ultrasonography and computed tomography.
Laparoscopic resection was decided upon based on the fact that there were clearly defined surgical planes despite of the size of the mass. The usual sequence of steps for a pancreaticoduodenectomy was altered in this particular case because of tumor dimensions.
The procedure was carried out in 438 minutes without complications. There were no symptoms of delayed gastric emptying, and the patient was discharged on postoperative day 5. The microscopic study of the tumor confirmed a 10.5 by 9 by 5.5cm solid pseudo-papillary tumor of the pancreatic head.
Thoracoscopic Bochdalek hernia repair in a newborn
Congenital diaphragmatic hernias (CDH) occur when muscle portions of the diaphragm fail to develop normally, resulting in the displacement of abdominal components into the thoracic cavity.
CDHs occur mainly during the eighth to the tenth weeks of fetal life. Bochdalek hernias, caused by posterolateral defects of diaphragm, usually present with severe respiratory distress immediately after birth, which is life-threatening. Once diagnosed, Bochdalek hernias should be surgically treated during the neonatal period.
We present a clinical case of a newborn with 38 weeks of gestation with the prenatal diagnosis of left diaphragmatic hernia. A thoracoscopic repair was performed with parent agreement.
C Sousa, A Coelho, F Carvalho
Surgical intervention
3 years ago
1387 views
71 likes
0 comments
02:43
Thoracoscopic Bochdalek hernia repair in a newborn
Congenital diaphragmatic hernias (CDH) occur when muscle portions of the diaphragm fail to develop normally, resulting in the displacement of abdominal components into the thoracic cavity.
CDHs occur mainly during the eighth to the tenth weeks of fetal life. Bochdalek hernias, caused by posterolateral defects of diaphragm, usually present with severe respiratory distress immediately after birth, which is life-threatening. Once diagnosed, Bochdalek hernias should be surgically treated during the neonatal period.
We present a clinical case of a newborn with 38 weeks of gestation with the prenatal diagnosis of left diaphragmatic hernia. A thoracoscopic repair was performed with parent agreement.
Laparoscopic diamond-shaped repair of duodenal atresia
This is the case of a female newborn weighing 1080 grams, delivered at 29 weeks of gestational age due to the premature rupture of membranes. An abdominal radiography was performed in the clinical setting of non-bilious vomiting and absence of meconium passage. It revealed the double bubble sign, pathognomonic for congenital duodenal obstruction. Laparoscopy showed a type I duodenal atresia and a diamond-shaped duodenal anastomosis was performed maintaining the minimally invasive approach. Duodenal atresia represents one of the most challenging conditions for a laparoscopic skilled pediatric surgeon. This video shows that the procedure is feasible even in a low-birth-weight (LBW) premature newborn.
J Correia-Pinto, AR Silva, V Trocado
Surgical intervention
4 years ago
1016 views
28 likes
0 comments
08:31
Laparoscopic diamond-shaped repair of duodenal atresia
This is the case of a female newborn weighing 1080 grams, delivered at 29 weeks of gestational age due to the premature rupture of membranes. An abdominal radiography was performed in the clinical setting of non-bilious vomiting and absence of meconium passage. It revealed the double bubble sign, pathognomonic for congenital duodenal obstruction. Laparoscopy showed a type I duodenal atresia and a diamond-shaped duodenal anastomosis was performed maintaining the minimally invasive approach. Duodenal atresia represents one of the most challenging conditions for a laparoscopic skilled pediatric surgeon. This video shows that the procedure is feasible even in a low-birth-weight (LBW) premature newborn.
Full laparoscopic pediatric 2-port gastrostomy using the U-stitch technique
This video illustrates a 2-port laparoscopic technique for gastrostomy button placement in a 2-year-old boy with spastic quadriparesis secondary to prolonged cardiorespiratory arrest and hypothermia.
The laparoscopic approach for G-tube or G-button placement offers several advantages when compared to the percutaneous technique such as:
- an accurate choice of the site for tube placement (both on the gastric and on the abdominal wall);
- allows direct placement of a G-button, thus avoiding the need of an intragastric bumper and of a second anesthesia for its removal;
- additionally, it allows for blunt or sharp adhesiolysis when needed as for example in cases of previous abdominal surgery or when a ventriculoperitoneal shunt is in place.
The procedure is easily accomplished and requires a short learning curve to be reproduced. Additionally, it proves safer than the percutaneous techique particularly in patients with distorted anatomy due to kyphoscoliosis or visceromegaly, which entail the risk of injury to interposed organs.
L Nanni, VF Paradiso, A Inserra
Surgical intervention
4 years ago
1147 views
24 likes
1 comment
06:25
Full laparoscopic pediatric 2-port gastrostomy using the U-stitch technique
This video illustrates a 2-port laparoscopic technique for gastrostomy button placement in a 2-year-old boy with spastic quadriparesis secondary to prolonged cardiorespiratory arrest and hypothermia.
The laparoscopic approach for G-tube or G-button placement offers several advantages when compared to the percutaneous technique such as:
- an accurate choice of the site for tube placement (both on the gastric and on the abdominal wall);
- allows direct placement of a G-button, thus avoiding the need of an intragastric bumper and of a second anesthesia for its removal;
- additionally, it allows for blunt or sharp adhesiolysis when needed as for example in cases of previous abdominal surgery or when a ventriculoperitoneal shunt is in place.
The procedure is easily accomplished and requires a short learning curve to be reproduced. Additionally, it proves safer than the percutaneous techique particularly in patients with distorted anatomy due to kyphoscoliosis or visceromegaly, which entail the risk of injury to interposed organs.
Laparoscopic management of a left diaphragmatic hernia in a newborn
Laparoscopic treatment of delayed diaphragmatic hernias in children has been described in 1995 by Klaas Bax and David Van der Zee. Since 2001, we managed to convince the community of pediatric surgeons that it was probably easier to choose a thoracoscopic approach. In some particular conditions, newborns with a congenital diaphragmatic hernia could be treated by thoracoscopy. Until now, more than 400 newborns have been operated on by thoracoscopy to treat a diaphragmatic hernia. Guidelines to specify the appropriate group of newborns for this approach remain discussed in the literature.
Reference:
Congenital diaphragmatic hernia: an evaluation of risk factors for failure of thoracoscopic primary repair in neonates. Gomes Ferreira C, Kuhn P, Lacreuse I, Kasleas C, Philippe P, Podevin G, Bonnard A, Lopez M, De Lagausie P, Petit T, Lardy H, Becmeur F. J Pediatr Surg 2013;48:488-95.
F Becmeur, C Gomes Ferreira
Surgical intervention
5 years ago
1988 views
51 likes
0 comments
03:45
Laparoscopic management of a left diaphragmatic hernia in a newborn
Laparoscopic treatment of delayed diaphragmatic hernias in children has been described in 1995 by Klaas Bax and David Van der Zee. Since 2001, we managed to convince the community of pediatric surgeons that it was probably easier to choose a thoracoscopic approach. In some particular conditions, newborns with a congenital diaphragmatic hernia could be treated by thoracoscopy. Until now, more than 400 newborns have been operated on by thoracoscopy to treat a diaphragmatic hernia. Guidelines to specify the appropriate group of newborns for this approach remain discussed in the literature.
Reference:
Congenital diaphragmatic hernia: an evaluation of risk factors for failure of thoracoscopic primary repair in neonates. Gomes Ferreira C, Kuhn P, Lacreuse I, Kasleas C, Philippe P, Podevin G, Bonnard A, Lopez M, De Lagausie P, Petit T, Lardy H, Becmeur F. J Pediatr Surg 2013;48:488-95.
Laparoscopic gastric pull-up in long-gap esophageal atresia
This is the case of a 2-year-old male preschooler, diagnosed with type III esophageal atresia. During the neonatal period, the patient had a right thoracotomy. Ligation of a tracheo-esophageal fistula and an esophago-esophagostomy were carried out, but failed because there was a long gap atresia. The measured gap of four vertebrae confirmed the diagnosis of long gap esophageal atresia; upon its evaluation by a multidisciplinary team, a laparoscopic gastric pull-up was carried out using 4 trocars: one 12mm, two 5mm and one 3mm trocar. The 6-hour duration of surgery was due to a firm adhesion of the esophagus to the posterior mediastinum. The patient had a favorable outcome without major complications. He remained in PICU for 72 hours and was extubated 48 hours after surgery. This is the sixth case of this particular pediatric surgeon and although our follow-up is still underway, we believe that laparoscopic pediatric surgeons with a certain degree of experience would be able to reproduce this technique, which is an excellent therapeutic option for the management of long gap esophageal atresia with good postoperative results.
A Parilli, W Garcia, I Galdon, G Contreras
Surgical intervention
6 years ago
2199 views
24 likes
0 comments
10:54
Laparoscopic gastric pull-up in long-gap esophageal atresia
This is the case of a 2-year-old male preschooler, diagnosed with type III esophageal atresia. During the neonatal period, the patient had a right thoracotomy. Ligation of a tracheo-esophageal fistula and an esophago-esophagostomy were carried out, but failed because there was a long gap atresia. The measured gap of four vertebrae confirmed the diagnosis of long gap esophageal atresia; upon its evaluation by a multidisciplinary team, a laparoscopic gastric pull-up was carried out using 4 trocars: one 12mm, two 5mm and one 3mm trocar. The 6-hour duration of surgery was due to a firm adhesion of the esophagus to the posterior mediastinum. The patient had a favorable outcome without major complications. He remained in PICU for 72 hours and was extubated 48 hours after surgery. This is the sixth case of this particular pediatric surgeon and although our follow-up is still underway, we believe that laparoscopic pediatric surgeons with a certain degree of experience would be able to reproduce this technique, which is an excellent therapeutic option for the management of long gap esophageal atresia with good postoperative results.
Laparoscopic resection of giant hepatic cystadenoma
This is the case of a 22-month-old female infant. The pathology started two weeks before with a gradual increase of abdominal circumference and intermittent hypo-colic stools. A CT-scan of the abdomen showed a large cystic tumor with interior partitions measuring 16.5 in width by 10.6 in length by 12.1cm in depth, originating in segments V and VI of the liver, displacing the remaining liver to the left and compressing the right kidney, bowel, celiac artery, gallbladder, and pancreas. A laparoscopic approach for tumor resection was decided on due to the scarce tumor vascularization and entirely cystic consistency. The procedure required 4 ports, three of 5mm and one of 3mm, emptying the cystic content of approximately 2 liters of citrine fluid. Dissection was performed using the Ligasure™ vessel-sealing device and monopolar cautery, preserving adjacent vital structures and preventing bleeding. The surgical specimen was removed through the umbilical scar. No transfusion was required and surgery lasted four hours. There were no postoperative complications. As a result, laparoscopic surgery is considered a safe procedure for the excision of large tumors in children provided they are cystic and benign, as emptying the cyst gives broader visualization of the area and permits better tissue handling.
A Parilli, W Garcia, I Galdon, G Contreras
Surgical intervention
6 years ago
1121 views
9 likes
0 comments
08:03
Laparoscopic resection of giant hepatic cystadenoma
This is the case of a 22-month-old female infant. The pathology started two weeks before with a gradual increase of abdominal circumference and intermittent hypo-colic stools. A CT-scan of the abdomen showed a large cystic tumor with interior partitions measuring 16.5 in width by 10.6 in length by 12.1cm in depth, originating in segments V and VI of the liver, displacing the remaining liver to the left and compressing the right kidney, bowel, celiac artery, gallbladder, and pancreas. A laparoscopic approach for tumor resection was decided on due to the scarce tumor vascularization and entirely cystic consistency. The procedure required 4 ports, three of 5mm and one of 3mm, emptying the cystic content of approximately 2 liters of citrine fluid. Dissection was performed using the Ligasure™ vessel-sealing device and monopolar cautery, preserving adjacent vital structures and preventing bleeding. The surgical specimen was removed through the umbilical scar. No transfusion was required and surgery lasted four hours. There were no postoperative complications. As a result, laparoscopic surgery is considered a safe procedure for the excision of large tumors in children provided they are cystic and benign, as emptying the cyst gives broader visualization of the area and permits better tissue handling.
Subtotal laparoscopic pancreatectomy for the treatment of hyperinsulinism in a 12-year-old girl
We present the case of a 12-year-old girl who presented with symptoms of dizziness and weakness for 4 months. Hyperinsulinemic hypoglycemia was found. Pancreatic PET-scan and CT-scan showed no focal lesions and a slightly increased volume of the pancreatic tail. After selective calcium stimulation of the pancreas, increased insulin was found from the body and tail. Laparoscopic pancreatectomy was scheduled. Failure with prednisone treatment indicated laparoscopic subtotal pancreatectomy.
Surgery was carried out using a four-trocar technique. The pancreas was approached through the greater omentum. Careful dissection of the small pancreatic vessels coming from the splenic vessels is performed. A subtotal pancreatectomy near the duodenum was carried out by means of the Endo-GIA® linear stapler in the head and ultrasonic scalpel and hook in the body and tail. Drainage was left in situ.
E Bracho, E Fernàndez, C Zalles
Surgical intervention
7 years ago
1823 views
10 likes
0 comments
09:00
Subtotal laparoscopic pancreatectomy for the treatment of hyperinsulinism in a 12-year-old girl
We present the case of a 12-year-old girl who presented with symptoms of dizziness and weakness for 4 months. Hyperinsulinemic hypoglycemia was found. Pancreatic PET-scan and CT-scan showed no focal lesions and a slightly increased volume of the pancreatic tail. After selective calcium stimulation of the pancreas, increased insulin was found from the body and tail. Laparoscopic pancreatectomy was scheduled. Failure with prednisone treatment indicated laparoscopic subtotal pancreatectomy.
Surgery was carried out using a four-trocar technique. The pancreas was approached through the greater omentum. Careful dissection of the small pancreatic vessels coming from the splenic vessels is performed. A subtotal pancreatectomy near the duodenum was carried out by means of the Endo-GIA® linear stapler in the head and ultrasonic scalpel and hook in the body and tail. Drainage was left in situ.
Redo transanal pull-through for Hirschsprung's disease
We present a case of a 3-year-old boy with a history of Hirschsprung’s Disease. He had been diagnosed at the age of two, and at that time underwent a laparoscopic-assisted Soave pull-through. He initially did well, but after a few months, had recurrent severe constipation with fecal impaction as well as an episode of enterocolitis. A contrast enema showed a dilated distal pull-through segment with normal-caliber sigmoid colon proximally, and an EUA found a preserved dentate line circumferentially with a stricture at the previous anastomosis. A biopsy was performed two centimeters proximal to the anastomosis and pathology was consistent with transition zone bowel with hypertrophic nerves and only occasional ganglion cells. We decided to do a redo transanal pull-through to remove the aganglionated and dilated segment of colon.
A Peña, M Levitt, A Bischoff, B Dickie
Surgical intervention
7 years ago
3530 views
50 likes
1 comment
05:14
Redo transanal pull-through for Hirschsprung's disease
We present a case of a 3-year-old boy with a history of Hirschsprung’s Disease. He had been diagnosed at the age of two, and at that time underwent a laparoscopic-assisted Soave pull-through. He initially did well, but after a few months, had recurrent severe constipation with fecal impaction as well as an episode of enterocolitis. A contrast enema showed a dilated distal pull-through segment with normal-caliber sigmoid colon proximally, and an EUA found a preserved dentate line circumferentially with a stricture at the previous anastomosis. A biopsy was performed two centimeters proximal to the anastomosis and pathology was consistent with transition zone bowel with hypertrophic nerves and only occasional ganglion cells. We decided to do a redo transanal pull-through to remove the aganglionated and dilated segment of colon.