Image-guided confirmation of a precision pull-through procedure during laparoscopically assisted anorectoplasty in an open MRI operating theater: first application in an infantile case with anorectal malformation

Abstract Background Image-guided surgery with an open magnetic resonance imaging (MRI) system is applied for brain tumors in the neurosurgery field, but has rarely been reported in pediatric surgery. We report our initial experience of intraoperative confirmation of precision rectal pull-through during laparoscopically assisted anorectoplasty (LAARP) in an open MRI operating theater for pediatric patients with anorectal malformation (ARM). Case presentation A 3.0 kg term male neonate was delivered with anorectal malformation. An invertogram revealed the intermediate type. Transverse colostomy was made on the left upper abdomen. The recto-bulbar urethral fistula (RBUF) was diagnosed by a distal colostogram and voiding cystourethrogram. LAARP was planned at 6 months of age. Because this was the first procedure in which the pediatric abdomen had been scanned in an open MRI operating theater in our institution, we scanned his pelvic floor under sedation 3 weeks before the operation using the open MRI system in our operation room. We performed the operation with 4 trocars. The peritoneal reflection was carefully incised and the rectum was dissected. The RBUF was resected. The center of the muscle complex was detected at the perineal skin with an electrical nerve stimulator, and a 7-mm longitudinal skin incision was made on the perineal lesion for anoplasty. The muscle complex and the pubo-rectal sling were confirmed laparoscopically using a 3.5-mm bipolar forceps connected to the electrical nerve stimulator. Anoplasty was performed between the rectal stump and perineal skin. After anoplasty, the patient was scanned with open MRI under general anesthesia. We attached the quadrature-detection (QD) head coil around the patient’s pelvis and inserted him in the gantry. A 0.45-T open MRI clearly revealed that the pulled through rectum was located in the center of the muscle complex on T2-weighted images. The postoperative course was uneventful. Oral intake was started on post-operative day 1. Postoperative dynamic urography showed no complication (e.g., leakage or residual fistula). Conclusions We successfully performed LAARP for ARM, with intraoperative confirmation of precision rectal pull-through in an open MRI operating theater. Further cases are required to evaluate the application of open MRI systems in pediatric surgery.

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Image-guided laparoscopic surgery in an open MRI operating theater

Surgical Endoscopy ◽

10.1007/s00464-012-2737-y ◽

2013 ◽

Vol 27 (6) ◽

pp. 2178-2184 ◽

Cited By ~ 25

Author(s):

Norifumi Tsutsumi ◽

Morimasa Tomikawa ◽

Munenori Uemura ◽

Tomohiko Akahoshi ◽

Yoshihiro Nagao ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Operating Theater ◽

Open Mri ◽

Image Guided

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Dr. Orvar Swenson and the Pull-Through

The American Surgeon ◽

10.1177/000313481908501221 ◽

2019 ◽

Vol 85 (12) ◽

pp. 1311-1313

Author(s):

John J. Newland ◽

Katerina Dukleska ◽

Scott Cowan ◽

Charles J. Yeo ◽

Renee Tholey

Keyword(s):

Pediatric Surgery ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Toxic Megacolon ◽

Bowel Function ◽

Standard Textbook ◽

Surgery Research ◽

Peter Bent Brigham Hospital ◽

Pull Through ◽

Rectal Biopsies

Dr. Orvar Swenson is best remembered for developing the Swenson pull-through, a technique he developed to treat Hirschsprung's disease. After graduating from Harvard Medical School and beginning his residency at Peter Bent Brigham Hospital, Dr. Swenson observed that patients with Hirschsprung's disease and toxic megacolon resumed normal bowel function after placement of transverse colostomies. His observation led to studying the patency of his patients’ colons using barium enema contrast studies. At the collapsed portion of the colon, he performed rectal biopsies leading to the discovery that the cause of Hirschsprung's disease is that the collapsed portion of the colon lacks the Auerbach plexus. The Swenson pull-through removes this aganglionic portion of the colon and cures the patient. His career grew from there as he traveled to academic institutions teaching his technique. He is remembered fondly for his contributions to pediatric surgery through the restructuring of pediatric surgery departments, pediatric surgery research, and writing and editing multiple volumes of Pediatric Surgery, the standard textbook for pediatric surgeons. He died peacefully in 2012 at the age of 103 years.

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COMPARISON OF CLINICAL OUTCOMES IN PATIENTS WITH CONGENITAL ANORECTAL MALFORMATION TREATED WITH POSTERIOR SAGITTAL ANORECTOPLASTY AND LAPAROSCOPICALLY ASSISTED ANORECTAL PULL THROUGH

Indian Journal of Child Health ◽

10.32677/ijch.2016.v03.i04.015 ◽

2016 ◽

Vol 03 (04) ◽

pp. 330-334

Author(s):

Vijaymahantesh S Kunnur ◽

Chandra Shekhar Singh ◽

Shanthala V Kunnur ◽

Anil Kumar S Kunnur

Keyword(s):

Clinical Outcomes ◽

Anorectal Malformation ◽

Posterior Sagittal Anorectoplasty ◽

Pull Through

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Experience with laparoscopic-assisted anorectal pull-through in 25 males with anorectal malformation and rectourethral or rectovesical fistulae: postoperative complications and functional results

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2012.08.001 ◽

2013 ◽

Vol 48 (3) ◽

pp. 591-596 ◽

Cited By ~ 23

Author(s):

Soo-Min Jung ◽

Suk-Koo Lee ◽

Jeong-Meen Seo

Keyword(s):

Postoperative Complications ◽

Anorectal Malformation ◽

Functional Results ◽

Pull Through ◽

Laparoscopic Assisted

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Image-Guided Pediatric Surgery Using Indocyanine Green (ICG) Fluorescence in Laparoscopic and Robotic Surgery

Frontiers in Pediatrics ◽

10.3389/fped.2020.00314 ◽

2020 ◽

Vol 8 ◽

Author(s):

Ciro Esposito ◽

Alessandro Settimi ◽

Fulvia Del Conte ◽

Mariapina Cerulo ◽

Vincenzo Coppola ◽

...

Keyword(s):

Robotic Surgery ◽

Indocyanine Green ◽

Pediatric Surgery ◽

Image Guided

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Current Image-Guided Interventions in Pediatric Surgery

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1703013 ◽

2020 ◽

Vol 30 (02) ◽

pp. 164-171

Author(s):

Nathan S. Rubalcava ◽

Marcus D. Jarboe

Keyword(s):

Image Quality ◽

Surgical Technique ◽

Minimally Invasive ◽

Pediatric Surgery ◽

Image Guidance ◽

Surgical Intervention ◽

Surgical Approaches ◽

Current Image ◽

Image Guided ◽

Invasive Management

AbstractTraditionally, surgical technique has not included imaging modalities. Image guidance had largely been left to radiology specialties. However, in recent years, tremendous advances in imaging have taken place with improvements in image quality, portability, and accessibility. With these advances, surgeons have begun to realize the benefits of fusing image guidance with traditional surgical approaches. Subsequently, many novel surgical approaches utilizing image guidance have been developed that allow for precise, safe, and minimally invasive management of conditions that previously required open surgical intervention.

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Analysis of Situation and Pattern of Diseases of the Neonates Admitted in Department of Pediatric Surgery of a Medical College Hospital

Journal of Surgical Sciences ◽

10.3329/jss.v24i1.52214 ◽

2020 ◽

Vol 24 (1) ◽

pp. 26-31

Author(s):

AK Mostaque ◽

Sayed Zahid Hossain

Keyword(s):

Congenital Anomaly ◽

Birth Weight ◽

Intestinal Obstruction ◽

Congenital Anomalies ◽

Anorectal Malformation ◽

Pediatric Surgery ◽

Emergency Laparotomy ◽

Neonatal Intestinal Obstruction ◽

The Mean ◽

The Difference

Background: Neonatal surgery (NS) is an extremely challenging leading edge of pediatric surgery. In our country NS death were 8% due to treatable congenital anomalies. The objectives of study were to observe yearly admission of NS patients, age of presentation, anthropometric records, prenatal record and types of congenital anomalies, and mortality of treated neonates. Materials and Methods: This cross-sectional study was conducted on 337 admitted neonates to assess the state of 70 consecutive NS patients admitted in the Pediatric Surgery ward. Birth weight was compared with randomly selected and sex matched 154 were neonatology neonates (NN), and 113 delivered un-admitted healthy neonates of the labor-ward (LN). The variables observed were number of neonatal surgical patients admitted, age of presentation, birth and admission weight, prenatal ultrasonogram for fetal anomalies and the types of anomalies, outcome (mortality) of neonatal surgery. Results: The mean age of surgical neonates at the time of admission was 5.7 ± 6.39 (1-25) days. Mean birth weight of surgical and neonatology neonates was 2.66 ± 0.76 (1.5-4.5) kg and 2.24 ± 0.71 (0.9-4) kg respectively. The difference was significant (p < 0.01). The mean admission weight of the surgical and neonatology neonates were 2.57 ± 0.66 (1.4-4.1) kg and 2.25 ± 0.62 (0.8-4.1) kg respectively showing significant difference (p < 0.01). Ten percent of NS patients and 38.3% of NN patients had records of prenatal ultrasonogram, and their reports were normal fetus. The difference was significant (Z = 4.36). Eighty seven percent NS patients and 49% NNs were delivered at home and the difference was significant (Z = 4.49). Major surgical problem were anorectal malformation (48.6%) and neonatal intestinal obstruction (20%). The treatments given to the patient admitted in the pediatric surgery ward were emergency laparotomy with resection-anastomosis, ileostomy, and transverse loop colostomy in 29 (41.3%), anoplasty 21 (30%), incision and drainage of abscess 5 (7.1%), and conservative treatment 15 (21.43%). The mortality rate of neonatal surgical and neonatology patients was 12.9% and 13% respectively. Conclusion: The number of NS patients (work load) indicated the necessity of establishment of a NS unit which could be viable. The mortality of NS patients were due to low birth weight, and delivery at home causing transport delay from birth place to the pediatric surgery ward because of lack of prenatal awareness of presence of congenital anomalies. Anorectal malformation is the commonest congenital anomaly, followed by neonatal intestinal obstruction. Emergency laparotomy was the major surgical intervention offered. To improve the survival of the NS patients, prenatal diagnosis of the congenital anomaly, mandatory delivery at defined hospital, rapid transport of the surgical neonates born away from hospital, and establishment of a NS unit in tertiary level hospitals were indicated. Journal of Surgical Sciences (2020) Vol. 24 (1) : 26-31

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Implantation of a Recurrent Laryngeal Nerve Stimulator for the Treatment of Spastic Dysphonia

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948909800209 ◽

1989 ◽

Vol 98 (2) ◽

pp. 130-134 ◽

Cited By ~ 19

Author(s):

Michael Friedman ◽

Vytenis T. Grybauskas ◽

Dean M. Toriumi ◽

Edward L. Applebaum

Keyword(s):

Recurrent Laryngeal Nerve ◽

Botulinum Toxin Injection ◽

Laryngeal Nerve ◽

Nerve Stimulator ◽

Peripheral Nerve Stimulator ◽

Cuff Electrode ◽

Relative Safety ◽

Muscle Complex ◽

Long Term Follow Up ◽

Cardiopulmonary Monitoring

Spastic dysphonia, a rare speech disorder, is characterized by strained phonation with excessively adducted vocal cords. Recurrent laryngeal nerve section, botulinum toxin injection into the vocalis-thyroarytenoid muscle complex, and other techniques have been used to treat this disorder. We have used percutaneous electrical stimulation of the recurrent laryngeal nerve with good results. Previous dog studies demonstrated the relative safety of an implantable recurrent laryngeal nerve stimulator. In this study, we directly stimulated the recurrent laryngeal nerve and vagus nerve in a dog without change in cardiorespiratory status. A Medtronic peripheral nerve stimulator was implanted in a patient with abductor spastic dysphonia. The cuff electrode was positioned around the recurrent laryngeal nerve and stimulation resulted in improvement in her voice. Extensive cardiopulmonary monitoring did not reveal any adverse response to stimulation and there was no discomfort to the patient. On the basis of the good results of this preliminary study, further study with long-term follow-up is under way.

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