Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center

Abstract Background Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations. Case presentation We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2–13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244–265 min); median blood loss was estimated at 100 ml (range, 15–175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1–6 days). All patients remain disease-free at median follow-up of 19 months (range, 12–30 months). Conclusion Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.

Download Full-text

Comparison of Laparoscopic versus Open Appendicectomy

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v10i2.25928 ◽

2015 ◽

Vol 10 (2) ◽

pp. 75-79

Author(s):

SM Shahadat Hossain ◽

Farhana Israt Jahan ◽

Munshi M Mujibur Rahman ◽

Md Abdus Samad Al Azad ◽

Md Shahinur Rahman ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Acute Appendicitis ◽

Hospital Stay ◽

Operating Time ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Armed Forces ◽

P Value ◽

Surgical Trauma ◽

Open Approach

Introduction: The advent of laparoscopic surgery has dramatically changed the field of surgery. With improvements in the equipment and increasing clinical experience it is now possible to perform almost any kind of procedure under laparoscopic visualization. The idea of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities, and better cosmetic outcome have made laparoscopic surgery for acute appendicitis very attractive.Objective: The aim of the present study was to compare the laparoscopic approach and the conventional technique in the treatment of acute appendicitis.Method: This prospective randomized clinical trial was conducted at CMH, Savar Cantonment and Navy Hospital, BNS Patenga, Chittagong. A total of 86 patients who underwent appendicectomy during December 2009 to March 2011 were included in this study. A total of 40 patients had laparoscopic appendicectomy and 46 underwent open procedure. Clinical outcome measures were compared between the two groups with respect to several variables.Results: Among the study population, the operating time was shorter for the OA patients than for the LA patients (LA, 35 min vs. OA, 30 min; p value 0.33), which is not statistically significant. The differences in hospital stay of 4 days for the LA group and 8 days for the OA group and p value 0.01 which is statistically significant. Return to oral diet was same in both groups with no statistical difference LA, 20 h vs. OA, 22 h; return to work LA was 14 days vs. OA 18 days. Although the rate for overall complications was lower in the LA group 5% vs. 18% in OA; p value 0.001 which is statistically significant.Conclusion: The laparoscopic approach to appendicectomy in patients with acute appendicitis does offer a significant advantage over the open approach in terms of length of hospital stay, postoperative complications, or quality of life, which are considered as the major advantages of minimally invasive surgery.Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014

Download Full-text

A Comparative Study on the Bilateral Areolar Endoscopic Approach Versus the Conventional Open Approach for Thyroidectomy

10.21203/rs.3.rs-567435/v1 ◽

2021 ◽

Author(s):

xiao ma ◽

Qi-Jun Xia ◽

Yun-Tao Song ◽

Tian-Xiao Wang

Keyword(s):

Blood Loss ◽

Lymph Nodes ◽

Hospital Stay ◽

Operating Time ◽

Length Of Hospital Stay ◽

Endoscopic Approach ◽

Open Approach ◽

Advantages And Disadvantages ◽

Removal Time ◽

Conventional Open Approach

Abstract Background: To compare the safety, advantages and disadvantages of thyroidectomy for differentiated thyroid carcinoma (DTC) via the bilateral areolar endoscopic approach (BAA) and the conventional open approach (COA).Methods: Eighty-six female patients who underwent thyroidectomy were enrolled and divided into two groups, 42 in the BAA group and 44 in the COA group, according to aesthetic requirements. The operating time, blood loss during surgery, number of dissected lymph nodes, length of hospital stay, drainage removal time and surgical complications between the two surgical approaches were compared. The pain score and cosmetic results of operative incisions were evaluated with the visual analog scale (VAS).Results: Patients in the BAA group had significantly less intraoperative blood loss and a significantly shorter scar length (P < 0.001) than those in the COA group. However, the operation time of 97.6 minutes in the BAA group was significantly longer than that in the COA group (76.4 minutes; P < 0.001). Comparison of the number of central lymph nodes (CLNs) dissected, drainage removal time and length of hospital stay revealed no significant differences (P>0.05). Patients in the BAA group experienced significantly less pain than those in the COA group (P<0.001). Similarly, patients were significantly more satisfied with the cosmetic outcomes resulting from the BAA than from the COA (P <0.001).Conclusions: These results show that BAA thyroidectomy exhibits superior advantages in clinical outcomes, such as causing less pain and achieving better cosmetic satisfaction, compared with COA thyroidectomy. Therefore, BAA thyroidectomy is a safe and ideal surgical method for DTC.

Download Full-text

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab040 ◽

2021 ◽

Author(s):

Jonathan P Scoville ◽

Evan Joyce ◽

Joshua Hunsaker ◽

Jared Reese ◽

Herschel Wilde ◽

...

Keyword(s):

Hospital Stay ◽

Chart Review ◽

Statistical Tests ◽

Case Series ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Opioid Use ◽

Pain Scores ◽

Surgical Methods ◽

Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

Download Full-text

Haemostatic devices in parotid surgery: a systematic review

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001973 ◽

2021 ◽

pp. 1-7

Author(s):

L Allen ◽

C MacKay ◽

M H Rigby ◽

J Trites ◽

S M Taylor

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Facial Nerve ◽

Hospital Stay ◽

Outcome Measures ◽

Meta Analysis ◽

Operating Time ◽

Length Of Hospital Stay ◽

Operative Blood Loss ◽

Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

Download Full-text

Transnasal endoscopic approach for pediatric skull base lesions: a case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.4.peds18693 ◽

2019 ◽

Vol 24 (3) ◽

pp. 246-257 ◽

Cited By ~ 1

Author(s):

Jennifer L. Quon ◽

Lily H. Kim ◽

Peter H. Hwang ◽

Zara M. Patel ◽

Gerald A. Grant ◽

...

Keyword(s):

Skull Base ◽

Pediatric Population ◽

Case Series ◽

Length Of Hospital Stay ◽

Skull Base Tumors ◽

Presenting Symptoms ◽

Institutional Experience ◽

Transnasal Endoscopic Approach ◽

Skull Base Lesions

OBJECTIVETransnasal endoscopic transsphenoidal approaches constitute an essential technique for the resection of skull base tumors in adults. However, in the pediatric population, sellar and suprasellar lesions have historically been treated by craniotomy. Transnasal endoscopic approaches are less invasive and thus may be preferable to craniotomy, especially in children. In this case series, the authors present their institutional experience with transnasal endoscopic transsphenoidal approaches for pediatric skull base tumors.METHODSThe authors retrospectively reviewed pediatric patients (age ≤ 18 years) who had undergone transnasal endoscopic transsphenoidal approaches for either biopsy or resection of sellar or suprasellar lesions between 2007 and 2016. All operations were performed jointly by a team of pediatric neurosurgeons and skull base otolaryngologists, except for 8 cases performed by one neurosurgeon.RESULTSThe series included 42 patients between 4 and 18 years old (average 12.5 years) who underwent 51 operations. Headache (45%), visual symptoms (69%), and symptoms related to hormonal abnormalities (71%) were the predominant presenting symptoms. Improvement in preoperative symptoms was seen in 92% of cases. Most patients had craniopharyngiomas (n = 16), followed by pituitary adenomas (n = 12), Rathke cleft cysts (n = 4), germinomas (n = 4), chordomas (n = 2), and other lesion subtypes (n = 4). Lesions ranged from 0.3 to 6.2 cm (median 2.5 cm) in their greatest dimension. Gross-total resection was primarily performed (63% of cases), with 5 subsequent recurrences. Nasoseptal flaps were used in 47% of cases, fat grafts in 37%, and lumbar drains in 47%. CSF space was entered intraoperatively in 15 cases, and postoperative CSF was observed only in lesions with suprasellar extension. There were 8 cases of new hormonal deficits and 3 cases of new cranial nerve deficits. Length of hospital stay ranged from 1 to 61 days (median 5 days). Patients were clinically followed up for a median of 46 months (range 1–120 months), accompanied by a median radiological follow-up period of 45 months (range 3.8–120 months). Most patients (76%) were offered adjuvant therapy.CONCLUSIONSIn this single-institution report of the transnasal endoscopic transsphenoidal approach, the authors demonstrated that this technique is generally safe and effective for different types of pediatric skull base lesions. Favorable effects of surgery were sustained during a follow-up period of 4 years. Further refinement in technology will allow for more widespread use in the pediatric population.

Download Full-text

Mini-open thoracoscopic-assisted spinal thoracotomy for traumatic injuries: A technical note

Surgical Neurology International ◽

10.25259/sni_435_2020 ◽

2020 ◽

Vol 11 ◽

pp. 265

Author(s):

Vikas Tandon ◽

Abhinandan Reddy Mallepally ◽

Ashok Reddy Peddaballe ◽

Nandan Marathe ◽

Harvinder Singh Chhabra

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operating Time ◽

Length Of Hospital Stay ◽

Neurological Status ◽

Technical Note ◽

Single Level ◽

Estimated Blood Loss ◽

Multiple Variables ◽

Mini Open

Background: Mini-open thoracoscopic-assisted thoracotomy (MOTA) has been introduced to mitigate disadvantages of conventional open anterior or conventional posterior only thoracoscopic procedures. Here, we evaluated the results of utilizing the MOTA technique to perform anterior decompression/fusion for 22 traumatic thoracic fractures. Methods: There were 22 patients with unstable thoracic burst fractures (TBF) who underwent surgery utilizing the MOTA thoracotomy technique. Multiple variables were studied including; the neurological status of the patient preoperatively/postoperatively, the level and type of fracture, associated injuries, operative time, estimated blood loss, chest tube drainage (intercostal drainage), length of hospital stay (LOS), and complication rate. Results: In 22 patients (averaging 35.5 years of age), T9 and T12 vertebral fractures were most frequently encountered. There were 20 patients who had single level and 2 patients who had two-level fractures warranting corpectomies. Average operating time and blood loss for single-level corpectomy were 91.5 ± 14.5 min and 311 ml and 150 ± 18.6 min and 550 ml for two levels, respectively. Mean hospital stay was 5 days. About 95.45% of cases showed fusion at latest follow-up. Average preoperative kyphotic angle corrected from 34.2 ± 3.5° to 20.5 ± 1.0° postoperatively with an average correction of 41.1% and correction loss of 2.4%. Conclusion: We concluded that utilization of the MOTA technique was safe and effective for providing decompression/fusion of traumatic TBF.

Download Full-text

Length of hospital stay in aneurysmal subarachnoid hemorrhage patients without vasospasm on angiography: potential for a fast-track discharge cohort

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017424 ◽

2021 ◽

pp. neurintsurg-2021-017424

Author(s):

Joshua S Catapano ◽

Visish M Srinivasan ◽

Kavelin Rumalla ◽

Mohamed A Labib ◽

Candice L Nguyen ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Length Of Stay ◽

Hospital Stay ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Length Of Hospital Stay ◽

Hospital Length Of Stay ◽

Neurologic Outcome ◽

Angiographic Vasospasm ◽

Fisher Grade ◽

Tertiary Center

BackgroundPatients with aneurysmal subarachnoid hemorrhage (aSAH) frequently suffer from vasospasm. We analyzed the association between absence of early angiographic vasospasm and early discharge.MethodsAll aSAH patients treated from August 1, 2007, to July 31, 2019, at a single tertiary center were reviewed. Patients undergoing diagnostic digital subtraction angiography (DSA) on post-aSAH days 5 to 7 were analyzed; cohorts with and without angiographic vasospasm (angiographic reports by attending neurovascular surgeons) were compared. Primary outcome was hospital length of stay; secondary outcomes were intensive care unit length of stay, 30 day return to the emergency department (ED), and poor neurologic outcome, defined as a modified Rankin Scale (mRS) score >2.ResultsA total of 298 patients underwent DSA on post-aSAH day 5, 6, or 7. Most patients (n=188, 63%) had angiographic vasospasm; 110 patients (37%) did not. Patients without vasospasm had a significantly lower mean length of hospital stay than vasospasm patients (18.0±7.1 days vs 22.4±8.6 days; p<0.001). The two cohorts did not differ significantly in the proportion of patients with mRS scores >2 at last follow-up or those returning to the ED before 30 days. After adjustment for Hunt and Hess scores, Fisher grade, admission Glasgow Coma Scale score, and age, logistic regression analysis showed that the absence of vasospasm on post-aSAH days 5–7 predicted discharge on or before hospital day 14 (OR 3.4, 95% CI 1.8 to 6.4, p<0.001).ConclusionLack of angiographic vasospasm 5 to 7 days after aSAH is associated with shorter hospitalization, with no increase in 30 day ED visits or poor neurologic outcome.

Download Full-text

Single Port Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Preliminary Report

International Journal of Hepatology ◽

10.4061/2011/579203 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 16

Author(s):

Stephen Kin Yong Chang ◽

Maria Mayasari ◽

Iyer Shridhar Ganpathi ◽

Victor Lee Tswen Wen ◽

Krishnakumar Madhavan

Keyword(s):

Hepatocellular Carcinoma ◽

Laparoscopic Surgery ◽

Liver Resection ◽

Blood Loss ◽

Hospital Stay ◽

Laparoscopic Liver Resection ◽

Preliminary Report ◽

Single Port ◽

Operating Time ◽

Length Of Hospital Stay

Single port laparoscopic surgery is an emerging technique, now commonly used in cholecystectomy. The experience of using this technique in liver resection for hepatocellular carcinoma is described in a series of 3 cases with single port laparoscopic liver resection performed during 2010. All patients were male aged 61 to 70 years, with several comorbidities. There were no complications in this early series. The length of hospital stay was 3–5 days. The blood loss was 200–450 mL, with operating time between 142 and 171 minutes. We conclude that this technique is feasible and safe to perform in experienced centers.

Download Full-text

Robotic Stereotactic Assistance (ROSA) for Pediatric Epilepsy: A Single-Center Experience of 23 Consecutive Cases

Children ◽

10.3390/children7080094 ◽

2020 ◽

Vol 7 (8) ◽

pp. 94

Author(s):

Jonathon H. Nelson ◽

Samantha L. Brackett ◽

Chima O. Oluigbo ◽

Srijaya K. Reddy

Keyword(s):

Minimally Invasive ◽

Pediatric Patients ◽

Case Series ◽

Intractable Epilepsy ◽

Electrode Placement ◽

Perioperative Outcomes ◽

Surgical Approaches ◽

Single Center ◽

Invasive Approach ◽

Ablative Surgery

Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.

Download Full-text