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Pediatric surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
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
2411 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 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
1386 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 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
1987 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.