Intraoperative radiation therapy for pediatric sarcomas and other solid tumors.

Purpose: To evaluate local failure (LF) and toxicity after intraoperative radiation therapy (IORT) in pediatric solid tumors (ST).

Methods: A single-institution retrospective study of 96 pediatric patients (108 applications) with ST treated from 1995 to 2022 with IORT. LF was calculated via cumulative incidence function and overall survival (OS) by Kaplan-Meier method, both from the day of surgery.

Evidence-based surgical guidelines for treating children with Wilms tumor in low-resource settings.

Background: Survival of Wilms tumor (WT) is > 90% in high-resource settings but < 30% in low-resource settings. Adapting a standardized surgical approach to WT is challenging in low-resource settings, but a local control strategy is crucial to improving outcomes.

Objective: Provide resource-sensitive recommendations for the surgical management of WT.

Late Complication of Congenital Diaphragmatic Hernia Repair: Recurrent Small Bowel Obstruction.

Congenital diaphragmatic hernia (CDH) is associated with high early mortality. However, advances in newborn care have led to improved survival into adolescence and early adulthood. We report a 17-year-old adolescent boy with recurrent small bowel obstruction after CDH repair at 2 days of age.

The first six years of the APSA Travel Fellowship Program: Impact and lessons learned.

Introduction: The American Pediatric Surgical Association (APSA) travel fellowship was established in 2013 to allow pediatric surgeons from low- and middle-income countries to attend the APSA annual meeting. Travel fellows also participated in various clinical and didactic learning experiences during their stay in North America.

Methods: Previous travel fellows completed a survey regarding their motivations for participation in the program, its impact on their practice in their home countries, and suggestions for improvement of the fellowship.

Bone Conduction Headphones for Force Feedback in Robotic Surgery.

Bone conduction headphones (Fig. 1) offer the unique ability to provide auditory information to the user without obstructing external sounds. We apply this technology to robotic surgery to provide the surgeon with force feedback information with minimal distraction.

Presacral Medulloepithelioma: Case Report and Literature Review.

Medulloepithelioma is a rare early childhood tumor typically presenting in the intraocular region and neuroaxis. We report a rare case of a 2-year-old girl that presented with a peripheral medulloepithelioma in the presacral region. Examination of the tumor revealed that it lacked amplification of the 19q13.

A parent-science partnership to improve postsurgical pain management in young children: Co-development and usability testing of the Achy Penguin smartphone-based app.

Background: Young children are at risk for poorly managed pain after surgery, with significant negative consequence to their quality of life and health outcomes. Mobile applications offer a highly accessible, engaging, and interactive medium to improve pain assessment and management; however, they generally lack scientific foundation or support.

Aims: The aims of this study were to describe a successful parent-science partnership in the development and testing of Achy Penguin, a parent-developed iOS app to help assess and manage acute pain in young children, and to evaluate and refine the usability of Achy Penguin in young children with acute postoperative pain.

Proof of Concept Study: Investigating Force Metrics of an Intracorporeal Suturing Knot Task.

Background: Mastering proper force manipulation in minimally invasive surgery can take many hours of practice and training. Improper force control can lead to necrosis, infection, and scarring. A force-sensing skin (FSS) has been developed, which measures forces at the distal end of minimal access surgeries' (MAS) instruments without altering the instrument's structural integrity or the surgical workflow, and acts as a minimally disruptive add-on to any MAS instrument.

Novel force-sensing system for minimally invasive surgical instruments.

Mastering proper force manipulation in minimally invasive surgery can take many years. Improper force control can lead to necrosis, infection, and scarring. This paper describes a novel system to measure, log, and display external forces at the distal end of minimally invasive surgical instruments in real-time.

Extreme hepatic resections for the treatment of advanced hepatoblastoma: Are planned close margins an acceptable approach?

Background: Orthotopic liver transplantation (OLT) is considered the standard for children with hepatoblastoma (HB) in whom complete surgical resection is not possible. However, OLT is not always available or feasible.

Objective: To describe the outcome of children with HB who were initially deemed unresectable and underwent complex hepatectomy with planned close margins, and ultimately avoided OLT.

Expanding the Spectrum of Colonic Manifestations in Tuberous Sclerosis: L-Cell Neuroendocrine Tumor Arising in the Background of Rectal PEComa.

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous condition that predisposes to numerous proliferative lesions, including perivascular epithelioid cell tumors (PEComas), such as lymphangioleiomyomatosis (LAM) and angiomyolipomas, and rare neuroendocrine neoplasms. We describe herein a TSC2-harboring tuberous sclerosis patient manifesting with a synchronous well-differentiated L-cell rectal neuroendocrine tumor and leiomyomatosis-like LAM of the rectum. The background large bowel wall was thickened by confluent nodular areas comprising vessels and spindle-to-epithelioid cells, which are immunoreactive for myoid (smooth muscle actin, muscle specific actin, and desmin) and melanocytic markers (HMB45, Melan-A, microphthalmia transcription factor, and CD117).

Video assessment of laparoscopic skills by novices and experts: implications for surgical education.

Background: Previous investigators have shown that novices are able to assess surgical skills as reliably as expert surgeons. The purpose of this study was to determine how novices and experts arrive at these graded scores when assessing laparoscopic skills and the potential implications this may have for surgical education.

Methods: Four novices and four general laparoscopic surgeons evaluated 59 videos of a suturing task using a 5-point scale.

Analysis of motion in laparoscopy: the deconstruction of an intra-corporeal suturing task.

Background: This study analyzes instrument motion for segments of a defined intra-corporeal suturing task in a laparoscopic simulator. We describe a system providing real-time velocity and acceleration assessment in the performance of this task. Analysis of the deconstructed task segments allows targeted assessment and teaching.

Construct validity and reliability of a real-time multidimensional smartphone app to assess pain in children and adolescents with cancer.

We evaluated the construct validity (including responsiveness), reliability, and feasibility of the Pain Squad multidimensional smartphone-based pain assessment application (app) in children and adolescents with cancer, using 2 descriptive studies with repeated measures. Participants (8-18 years) undergoing cancer treatment were drawn from 4 pediatric cancer centers. In study 1, 92 participants self-reported their level of pain twice daily for 2 weeks using the Pain Squad app to assess app construct validity and reliability.

Construct validity and educational role for motion analysis in a laparoscopic trainer.

Background: Laparoscopic models for ex vivo up-skilling are becoming increasingly important components of surgical education. This study aims to establish the construct validity and possible educational role of a new laparoscopic box trainer equipped with a motion-tracking device.

Methods: A structured questionnaire was used to assign participants into novice, intermediate, or expert categories according to level of experience in minimal access surgery (MAS).

Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis.

Background/aim: Established indications for surgery in necrotizing enterocolitis (NEC) are pneumoperitoneum and failure to improve or clinical deterioration with medical treatment alone. It has been proposed that infants with intestinal necrosis may benefit from surgery in the absence of one of these indications yet the diagnosis of definitive intestinal necrosis is challenging. Recent data suggest that abdominal ultrasound (US) examination focused on the gastrointestinal tract and the peritoneal cavity may be of utility in this regard.

Motion analysis in the pediatric laparoscopic surgery (PLS) simulator: validation and potential use in teaching and assessing surgical skills.

Background: Construct validity for the pediatric laparoscopic surgery (PLS) simulator has been established through a scoring system based on time and precision. We describe the development and initial validation of motion analysis to teach and assess skills related to pediatric minimal access surgery (MAS).

Methods: Participants were asked to perform a standardized intracorporeal suturing task.

Comparative outcome analysis of the management of pediatric intussusception with or without surgical admission.

Background: Controversy persists about the need to admit patients after successful reduction of intussusception. Our hypothesis is that pediatric intussusception can be managed with discharge from the emergency department (ED) after reduction without increasing morbidity, yielding significant cost savings.

Methods: A chart review over 10 years was performed at two Canadian institutions.

Preoperative risk stratification of adnexal masses: can we predict the optimal surgical management?

Study Objective: To characterize preoperative risk stratification with aim of identifying the accurate surgical approach of benign and malignant adnexal masses in pediatric patients.

Design: A retrospective chart review of all cases of adnexal masses surgically managed between January 2001 and December 2006.

Setting: The Hospital for Sick Children, Toronto, Canada.

Loop versus divided colostomy for the management of anorectal malformations.

Purpose: The purpose of this study was to compare the clinical outcomes of loop and divided colostomies in patients with anorectal malformations (ARM).

Methods: We performed a retrospective cohort study reviewing the medical records of all patients with ARM managed with diverting colostomies between 2000 and 2010 at our institution. Independent variables and outcomes of stoma complications were analyzed by parametric measures and logistic regression.

The Pediatric Laparoscopic Surgery (PLS) simulator: methodology and results of further validation.

Background: The Pediatric Laparoscopic Surgery (PLS) simulator is the only validated tool for pediatric Minimal Access Surgery. Construct validity (the ability to discriminate between novice, intermediate and expert) for the PLS simulator had previously been established on the basis of the total PLS score, as well as the individual performance on three of the five tasks. We describe the process and methods used to establish independent construct validity for a fourth task: pattern-cutting.

Disorders of midgut rotation: making the correct diagnosis on UGI series in difficult cases.

Background: In some series of malrotation small numbers of children are described in whom the position of the duodenojejunal flexure was considered to be normal on straight anteroposterior (AP) view of an upper gastrointestinal (UGI) series.

Objective: The purpose of this study was to illustrate children with disorders of midgut rotation in whom the diagnosis was difficult because on the straight AP view of the UGI series the duodenojejunal flexure was either not clearly depicted or was projected to the left of the midline close to its expected normal position at or close to the level of the duodenal cap.

Materials And Methods: We reviewed 111 children with malrotation to determine the frequency that duodenojejunal flexure was not clearly depicted or was close to normal position.