Outcomes of bedside sutureless umbilical closure without endotracheal intubation for gastroschisis repair in surgical infants.

Introduction: Newborns with gastroschisis have historically undergone surgical repair under general anesthesia. Our institution recently transitioned to the sutureless umbilical closure for gastroschisis. We sought to evaluate the feasibility of bedside gastroschisis repair without endotracheal intubation.

Contemporary trends in the use of primary repair for gastroschisis in surgical infants.

Background: Gastroschisis is a newborn anomaly requiring emergent surgical intervention. We review our experience with gastroschisis to examine trends in contemporary surgical management.

Methods: Infants who underwent initial surgical management of gastroschisis from 1996 to 2014 at a pediatric hospital were reviewed.

Robotic surgery for pediatric tumors.

Robotic surgery is an ever-moving target of advancing technology. The need for prospective data may be a hallmark for good science, but collecting that data is difficult if not impossible in such a rapidly progressing technology. At present, published pediatric robotic outcomes data are very scarce, especially when it is filtered to select oncology.

Spontaneous Clostridium perfringens myonecrosis: Case report, radiologic findings, and literature review.

The utility of computed tomography (CT) has not been studied in the initial evaluation of a patient with suspected spontaneous Clostridial myonecrosis. Here, we present a patient with acute lymphoblastic leukemia (ALL) and neutropenia who developed spontaneous Clostridium perfringens myonecrosis after induction chemotherapy. Although suspected, the patient's symptoms and physical exam findings were not specific for Clostridial myonecrosis.

Robotic lateral pancreaticojejunostomy (Puestow).

A lateral pancreaticojejunostomy (LPJ), also known as the Puestow procedure, is a complex procedure performed for chronic pancreatitis when the pancreatic duct is dilated and unable to drain properly. Traditionally, these procedures are performed with open surgery. A minimally invasive approach to the LPJ using rigid handheld nonarticulating instruments is tedious and rarely performed.

Robotic surgery in small children: is there room for this?

Some pediatric surgeons may be reluctant to use robotic surgery for small patients because the only available surgical robot might seem too large for smaller patients. However, we have found this concern invalid. We have been successful in a wide variety of minimally invasive surgery procedures using robotics for general surgery applications in small children.

Robotic repair of congenital diaphragmatic anomalies.

Purpose: Congenital diaphragm anomalies, including eventration, Morgagni diaphragmatic hernias (M-CDH), and Bochdalek diaphragmatic hernias (B-CDH), have been successfully repaired by using minimally invasive surgery (MIS). However, some reports have shown a high recurrence rate for some defects, potentially due to difficulty associated with the rigid instruments. Robotic surgery may help close diaphragmatic anomalies more effectively.

Robotic repair of Morgagni congenital diaphragmatic hernia in an infant.

We describe a robotic repair of a large Morgagni congenital diaphragmatic hernia in a 12-month-old infant using the da Vinci surgical robot.

Robotic pulmonary resections in children: series report and introduction of a new robotic instrument.

Thermal sealing devices, such as the LigaSure (ValleyLab-Tyco Healthcare; Boulder, CO) or Gyrus PK (Gyrus ACMI, Maple Grove, MN) are minimally invasive instruments that can be used to seal the pulmonary parenchyma in pediatric lung resections. But these devices were only available in laparoscopic form, and no robotically similar instruments were manufactured. This handicaps the surgeon at the console, because these nonrobotic instruments must be manipulated and used by the bedside assistant instead of the console surgeon.

Erosion of the Nuss bar into the internal mammary artery 4 months after minimally invasive repair of pectus excavatum.

The minimally invasive repair of pectus excavatum has become increasingly popular. Life-threatening complications have included bleeding and cardiac perforation. There have been a number of delayed cases of bleeding, many of which never demonstrated a clear source.

The robotic Gyrus PK: a new articulating thermal sealing device and a preliminary series report.

Before 2006, thermal sealing devices, such as the LigaSure (ValleyLab-Tyco Healthcare, Boulder, CO) and the Gyrus (Gyrus ACMI, Maple Grove, MN), were not available for use with the Da Vinci Surgical Robot (Intuitive Surgical, Sunny Vale, CA). Surgeons had to incorporate standard nonarticulating handheld laparoscopic devices into their operations by having the bedside assistant use these devices. This took a significant portion of the procedure out of the hands of the operating surgeon.

Robotic resection of mediastinal masses in children.

Purpose: Robotic surgery may be particularly well suited for solid chest masses. In this paper, we present our initial experience by using robotic surgery to resect mediastinal masses in children.

Methods: Five pediatric patients with an average age of 9.

The robotic approach to complex hepatobiliary anomalies in children: preliminary report.

Purpose: Robotic technology allows surgeons to perform complex procedures which may be difficult with standard laparoscopic instruments. We believe that complex hepatobiliary procedures are ideally suited for robotic surgery in children and present our experience with Kasai portoenterostomy and excision of choledochal cysts.

Methods: We performed 4 complex hepatobiliary procedures in children using the Da Vinci surgical robot (Intuitive Surgical, Sunnyvale, CA): 2 Kasai portoenterostomies and 2 choledochal cyst resections.

Robotic fundoplication in children: resident teaching and a single institutional review of our first 50 patients.

Background: Robotic surgery is a new technology that may eventually replace laparoscopy in treating many surgical issues in children. Resident education using robotic surgery has been a concern for many institutions. We present our first 50 consecutive robotic fundoplications in children and our teaching experience with this procedure.

Robotic repair of a Bochdalek congenital diaphragmatic hernia in a small neonate: robotic advantages and limitations.

Minimally invasive repair for a Bochdalek congenital diaphragmatic hernia has been performed over the last few years with mixed results. Although the anomaly has been approached from both the abdomen and the chest, the defect can be difficult to close as the posterolateral region may be difficult to reach with precise suturing using standard rigid laparoscopic instruments. The articulating instruments of robotic surgery offer a substantial improvement in degrees of freedom and may help over come these obstacles.

Common bile duct perforation resulting from a gastric duplication cyst.

Gastric duplication cysts are a rare cause of abdominal masses in infants. Most children present with a gastric outlet obstruction or some vague abdominal complaints. We present an unusual case of a gastric duplication cyst that created a distal common bile duct obstruction which led to a proximal common bile duct perforation.

Robotic repair of congenital duodenal atresia: a case report.

Although repair of duodenal atresia has been performed laparoscopically, it can be a difficult procedure using rigid handheld laparoscopic instruments. Only a few pediatric surgeons are performing this operation with a minimally invasive approach. Robotic surgery may help overcome the obstacles presented by the use of traditional rigid laparoscopic instruments.

Pediatric robotic surgery: A single-institutional review of the first 100 consecutive cases.

Background: Robotic surgery is a new technology which may expand the variety of operations a surgeon can perform with minimally invasive techniques. We present a retrospective review of our first 100 consecutive robotic cases in children.

Methods: A three-arm robot was used with one camera arm and two instrument arms.

Surgical treatment of a gastric diverticulum in an adolescent.

Gastric diverticula are uncommonly seen in childhood. They typically emanate from the posterior wall of the stomach near the gastroesophageal junction. The authors report on a 15-year-old adolescent boy who presented with a symptomatic gastric diverticulum that was surgically resected.

Extrapleural benign solitary fibrous tumor in the shoulder of a 9-year-old girl: case report and review of the literature.

We report a case of a benign solitary fibrous tumor that occurred in the right shoulder of a 9-year-old girl. This case is remarkable due to the unusual location of its occurrence and the young age of the patient. In addition, cytogenetic analysis revealed a karyotype unreported in this neoplasm: 46,XX,der(4)t(4;9)(q31.