Robotic resection of a giant thymolipoma in a pediatric patient.

Thymolipomas are benign lesions in the anterior mediastinum that most commonly present in the first three decades of life. They often are asymptomatic and can be very large at time of diagnosis. After incidental detection of a thoracic mass on an abdominal ultrasound, an otherwise well 10 years old male was evaluated with further imaging, including a cardiac-gated magnetic resonance imaging (MRI) study.

Locum Tenens and Pediatric Surgery: A Position Statement and Practice Guidelines From the American Pediatric Surgical Association (APSA).

The American Pediatric Surgical Association (APSA) Practice Committee endorsed by the Board of Governors presents a Position Statement on the role of locum tenens in the practice of pediatric surgery. The Practice Committee also presents a set of guidelines for locum tenens practice. These recommendations highlight safe practice and quality care that protects the patient as well as the pediatric surgeon by offering best practice standards, defining optimal resources and establishing parameters by which hospitals and locum tenens agencies should abide.

Outcomes for pediatric acute lymphoblastic leukemia patients with intestinal perforation.

Objectives: Intestinal perforation during acute lymphoblastic leukemia (ALL) treatment in children is rare, but represents a severe complication with possible long-term consequences. In this study, we aim to provide an overview of the epidemiology and clinical characteristics of these patients; analyze surgical pathology findings for possible causes; and determine its impact on patients' therapy, nutritional status, and outcome.

Study Design: Historical chart review from January 2000 to October 2020 of children with ALL and intestinal perforation during therapy diagnosed at a single institution.

Interhospital variability in localization techniques for small pulmonary nodules in children: A pediatric surgical oncology research collaborative study.

Background: Pulmonary nodules that are deep within lung parenchyma and/or small in size can be challenging to localize for biopsy. This study describes current trends in performance of image-guided localization techniques for pulmonary nodules in pediatric patients.

Methods: A retrospective review was performed on patients < 21 years of age undergoing localization of pulmonary nodules at 15 institutions.

Higher rates of regional disease but improved outcomes in pediatric versus adult melanoma.

Background: Malignant melanoma is rare in the pediatric population and management is largely extrapolated from adult guidelines. Adult data have shown that immediate completion lymph node dissection (CLND) does not improve overall survival in selected patients with clinically node negative, sentinel lymph node-positive disease. Current nodal management in children is unknown.

Conflict resolution and negotiation in pediatric surgery.

Conflict is pervasive in pediatric surgery - it is experienced during patient care, in the operating room and between colleagues. The ethical principles of autonomy, beneficience, non-maleficience and justice are firmly anchored in any discourse regarding conflict in the setting of healthcare. The authors review key features of conflict in healthcare including the effect on patient outcomes as well as implications for the ability of the surgeon and the medical team to function appropriately and safely when conflicts arise.

Airway Clearance in Tracheomalacia.

Airway clearance is an essential part of airway maintenance to ensure the airway lumen is protected against particulate and infectious insults. The mechanisms involved in airway clearance include intrinsic structural and cellular components that can be impaired or inhibited through developmental defects and surgical interventions. Tracheomalacia is a developmental defect of the airway that can contribute to the mechanical failure to clear the airway.

Surgical Resection After Talimogene Laherparepvec for Melanoma: Persistent Fuorodeoxyglucose Avidity on Positron Emission Tomography Despite No Viable Disease.

Background: Talimogene laherparepvec (TVEC) is an injectable attenuated oncolytic herpes simplex virus (HSV-1) used in the treatment of loco regionally metastatic melanoma. Lesions managed by TVEC are generally considered unresectable at time of initiation of intralesional therapy; however, a subset of patients go on to have surgical resection of loco regionally controlled disease. We sought to review our experience with surgical excision of treated lesions to offer an insight into the radiologic correlate, treatment effect, and pathological findings of intralesional TVEC therapy.

Clinical significance of SLN benign capsular nevi in patients with melanoma.

Background: Benign capsular nevi (BCN) are not infrequent in sentinel lymph nodes (SLN) of patients with melanoma. Their prognostic significance is unknown and the literature is limited. This study evaluated the clinical significance of incidentally found BCN in these patients.

Magnetic Resonance-guided High-intensity Focused Ultrasound (MRgHIFU) Virtual Treatment Planning for Abdominal Neuroblastoma Utilizing Retrospective Diagnostic 3D CT Images.

Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) is a novel treatment for neuroblastoma using ultrasound-induced thermal ablation with real-time MR thermometry. It is unclear which patients would be amenable to MRgHIFU given the retroperitoneal location of many neuroblastomas within the smaller pediatric abdomen. In addition, planning relies on MR scans, which are not routine in the standard pediatric neuroblastoma workup.

Multifocal hepatoblastoma: What is the risk of recurrent disease in the remnant liver?

Purpose: Multifocal hepatoblastoma (HB) is often treated with total hepatectomy and transplantation owing to concerns of surgical resectability, local recurrence, and/or metachronous tumor in the remnant liver. We aimed to review HB patients to determine the risk of local recurrence in multifocal disease.

Methods: We undertook retrospective cohort analysis of all HB patients at a single tertiary referral center between 2001 and 2015.

Management of ovarian lesions diagnosed during infancy.

Purpose: Prior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively.

Methods: A retrospective study was performed of ovarian lesions in children <1 year-old from 2000 to 2014.

Refining How We Define Laparoscopic Expertise.

Background: Traditional stratification of expertise in laparoscopic simulation assigns participants to novice, intermediate, or expert groups based on case numbers. We hypothesized that expert video assessment might refine this discrimination of psychomotor expertise, especially in light of new measurable parameters.

Materials And Methods: One hundred five participants performed a defined intracorporeal suturing task in the pediatric laparoscopic surgery simulator armed with force-sensing capabilities.

Laparoscopic Revision of Ventriculoperitoneal Shunts in Pediatric Patients May Result in Fewer Subsequent Peritoneal Revisions.

Introduction: Ventriculoperitoneal shunts (VPSs) are the mainstay of treatment of hydrocephalus but frequently need revision. We sought to directly compare the impact of laparoscopic versus open peritoneal shunt revision on the need for subsequent VPS revisions in pediatric patients.

Materials And Methods: A prospectively maintained, externally validated database of pediatric patients who underwent a first peritoneal VPS revision at a single center between 2008 and 2016 was reviewed.

Refinement in the analysis of motion within low-cost laparoscopic simulators of differing size: Implications on assessing technical skills.

Background: Simulation is becoming more important in the teaching and assessment of technical skills. The purpose of this study was to refine the use of motion analysis parameters (MAPs) to assess performance of a defined task in low-cost pediatric laparoscopic simulators of differing size.

Methods: 105 participants performed a defined intracorporeal suturing task in large and small pediatric laparoscopic simulators.

A Systematic Review of Prenatally Diagnosed Intra-abdominal Enteric Duplication Cysts.

Introduction:  With improvements in prenatal ultrasound, more abdominal enteric duplication cysts (EDCs) are diagnosed prenatally. The optimal time for operative intervention is unclear. We aimed to review the evidence supporting the indication and timing of surgery for prenatally diagnosed EDCs.

Laparoscopic insertion of ventriculoperitoneal shunts in pediatric patients - A retrospective cohort study.

Introduction: Ventriculoperitoneal shunts (VPSs) are the mainstay of treatment of hydrocephalus but have frequent complications including shunt failure and infection. There has been no comparison of laparoscopic versus open primary VPS insertion in children. We hypothesized that laparoscopic VP shunt insertion may improve patient outcomes.

Long term outcomes after concurrent ipsilateral nephrectomy versus kidney-sparing surgery for high-risk, intraabdominal neuroblastoma.

Purpose: The impact of the extent of surgical resection including nephrectomy for high-risk neuroblastoma patients is controversial. In this study, we compared the renal late effects and long-term survival for patients who underwent kidney-sparing surgery (KSS) versus concurrent ipsilateral nephrectomy (CIN) for high-risk, intraabdominal neuroblastoma (HRIN).

Methods: A retrospective analysis of patients diagnosed with HRIN between Jan 1998 and Dec 2008 in a tertiary referral center was performed.

The Impact of Simulator Size on Forces Generated in the Performance of a Defined Intracorporeal Suturing Task: A Pilot Study.

In pediatric minimal access surgery, the operative domain may vary from that of an adult to that of a neonate. This study aimed to quantify the impact of decreased operative domain on forces generated in the performance of a defined intracorporeal suturing task. One hundred five participants performed a defined intracorporeal suturing task in small and large simulators.

Development of an Open-Source Laparoscopic Simulator Capable of Motion and Force Assessment: High Tech at Low Cost.

Objective: Laparoscopic simulators help improve surgical skills in an ex vivo setting. New simulators incorporate force and motion assessment, but often at high financial cost. Our goal is to establish global access to a laparoscopic simulator, which offers both traditional summative assessment (time to task completion and precision) as well as advanced formative assessment (force and motion sensing capabilities) so that educators anywhere may be able to create simulators with increased educational value.

Early Hospital Discharge After Helicopter Transport of Pediatric Trauma Patients: Analysis of Rates of Over and Undertriage.

Objectives: Helicopter air ambulance (HAA) of pediatric trauma patients is a life-saving intervention. Triage remains a challenge for both scene transport and interhospital transfer of injured children. We aimed to understand whether overtriage or undertriage was a feature of scene or interhospital transfer and how in or out of state transfers affected these rates.

Long-term outcomes for children with very early-onset colitis: Implications for surgical management.

Purpose: The timing of J-pouch surgery following colectomy for children with very early-onset colitis is controversial, with some advocating early reconstruction and others delaying reconstruction because of fear that the colitis may be owing to Crohn's disease (CD). We sought to determine the long-term incidence of CD in this population and whether there may be clinical features that predict the risk of CD.

Methods: Children with noninfectious colitis diagnosed prior to age 10, who underwent subtotal colectomy and ileostomy from 2000 to 2015, were reviewed.

Current Approaches to Pediatric Polyposis Syndromes.

Colorectal adenomatous polyposis syndromes encompass a diverse group of disorders with varying modes of inheritance and penetrance. Children may present with overt disease or within screening programs for families at high risk. We provide an overview of the array of pediatric polyposis syndromes, current screening recommendations, and surgical indications and technical considerations.

Colectomy in refractory Crohn's colitis improves nutrition and reduces steroid use.

Background: Pediatric patients with severe refractory Crohn's colitis (CC) may require total colectomy (TC) or diverting loop ileostomy (DLI). Our understanding of outcomes (postoperative complications, nutrition and restoration of intestinal continuity) is currently limited.

Methods: Pediatric patients with severe CC who underwent TC or DLI were identified.

Flat Epithelial Atypia on Core Biopsy and Upgrade to Cancer: a Systematic Review and Meta-Analysis.

Background: No consensus exists on whether flat epithelial atypia (FEA) diagnosed percutaneously should be surgically excised. A systematic review and meta-analysis of the frequency of upgrade to cancer or an atypical ductal hyperplasia (ADH) at surgical excision of FEA was performed.

Methods: Embase, MEDLINE, Scopus, and Web of Science databases from January 2003 to November 2015 were searched.