Per Oral Endoscopic Myotomy (POEM) for pediatric achalasia: Institutional experience and outcomes.

Background: The surgical treatment of achalasia by both laparoscopic and endoscopic approaches has been recognized as the definitive management in children. Despite reported low volumes in many centers, there has been an increasing worldwide experience with endoscopic approaches to pediatric achalasia. The aim of this study is to report our institutional experience with per oral endoscopic myotomy (POEM) as first-line or revisional therapy for achalasia.

Case series of metal allergy following Nuss procedure: Not only for stainless steel bars.

Background: Pectus excavatum is often managed with the Nuss procedure. Metal allergies to pectus bars occur in 5% of patients, though pre-operative testing is not generally routine.

Objectives: This study describes our experience with pre-operative metal allergy testing and post-operative allergic reactions to pectus bars.

Median Arcuate Ligament Syndrome with Orthostatic Intolerance: Intermediate-Term Outcomes following Surgical Intervention.

Objectives: To report the intermediate-term outcome following surgical intervention for median arcuate ligament syndrome (MALS) in adolescents and young adults with orthostatic intolerance (OI) to assess clinical improvement in the gastrointestinal and 5 other functional domains and if relief of arterial obstruction is associated with resolution of clinical symptoms.

Study Design: Thirty-one patients were given 2 dysautonomia-designed questionnaires to assess changes in symptoms following operative intervention in 6 functional domains and underwent postoperative repeat abdominal ultrasound examinations.

Results: Average follow-up after surgery was 22.

Preclinical evaluation of ultrasound-augmented needle navigation for laparoscopic liver ablation.

Purpose: For laparoscopic ablation to be successful, accurate placement of the needle to the tumor is essential. Laparoscopic ultrasound is an essential tool to guide needle placement, but the ultrasound image is generally presented separately from the laparoscopic image. We aim to evaluate an augmented reality (AR) system which combines laparoscopic ultrasound image, laparoscope video, and the needle trajectory in a unified view.

Evidence of GMPPA founder mutation in indigenous Guatemalan population associated with alacrima, achalasia, and mental retardation syndrome.

Congenital disorders of glycosylation (CDG) are a heterogeneous group of inborn errors of metabolism mostly causing multisystem disease. In 2013, biallelic mutations in the GMPPA gene were described in association with one such CDG known as alacrima, achalasia, and mental retardation syndrome (AAMR). To date, 18 patients have been reported, nearly all displaying the same pathognomonic triad of symptoms described in the name.

GPS Laparoscopic Ultrasound: Embedding an Electromagnetic Sensor in a Laparoscopic Ultrasound Transducer.

Tracking the location and orientation of a laparoscopic ultrasound (LUS) transducer is a prerequisite in many surgical visualization and navigation applications. Electromagnetic (EM) tracking is a preferred method to track an LUS transducer with an articulating imaging tip. The conventional approach to integrating EM tracking with LUS is to attach an EM sensor on the outer surface of the imaging tip (external setup), which is not ideal for routine clinical use.

Laparoscopic Liver Resection with Augmented Reality: A Preclinical Experience.

Introduction: Intraoperative imaging, such as ultrasound, provides subsurface anatomical information not seen by standard laparoscopy. Currently, information from the two modalities may only be integrated in the surgeon's mind, an often distracting and inefficient task. The desire to improve intraoperative efficiency has guided the development of a novel, augmented reality (AR) laparoscopic system that integrates, in real time, laparoscopic ultrasound (LUS) images with the laparoscopic video.

Congenital paraesophageal hernia: Contemporary results and outcomes of laparoscopic approach to repair in symptomatic infants and children.

Background: Congenital paraesophageal hernia (CPEH) is a rare diaphragmatic anomaly for which repair has primarily been described by laparotomy, although, more recent case series describe laparoscopic repair. In reports with over five patients, the predominant approach has been with laparotomy. The purpose of our study was to review our recent institutional experience and results with exclusively laparoscopic repair of CPEH in infants and children.

Lateral Pancreaticojejunostomy for Chronic Pancreatitis and Pancreatic Ductal Dilation in Children.

Background: Pancreatic ductal obstruction leading to ductal dilation and recurrent pancreatitis is uncommon in children. Treatment is dependent upon etiology but consists of decompression of the pancreatic duct (PD) proximally, if possible, by endoscopic retrograde cholangiopancreatography (ERCP) intervention or surgical decompression with pancreaticojejunal anastomosis.

Methods: After institutional review board approval, we retrospectively reviewed the records for 2 children who underwent lateral pancreaticojejunostomy for pancreatic ductal dilation.

Splenic myoid angioendothelioma mimicking metastatic disease in an 8-year-old with Stage IV Wilms' tumour.

Myoid angioendothelioma are rare and benign vascular tumours of the spleen. Radiographic evaluation and diagnosis is often challenging and subjecting tissue samples to immuhistochemical analysis is often required to make a definitive diagnosis. Myoidangioendotheliomas can be managed with open or laparoscopic splenectomy with minimal risk of recurrent disease.

Primary Omental Torsion in a Pediatric Patient: Case Report and Review of the Literature.

Primary omental torsion is a rare cause of acute abdominal pain with a clinical presentation resembling acute appendicitis. Here, we report the case of a 7-year-old child presenting with right lower quadrant pain. Primary omental torsion was discovered upon laparoscopy, and the torsed omentum was excised without postoperative complications.

Congenital H-type tracheoesophageal fistula: A multicenter review of outcomes in a rare disease.

Objective: To perform a multicenter review of outcomes in patients with H-type tracheoesophageal fistula (TEF) in order to better understand the incidence and causes of post-operative complications.

Background: H-type TEF without esophageal atresia (EA) is a rare anomaly with a fundamentally different management algorithm than the more common types of EA/TEF. Outcomes after surgical treatment of H-type TEF are largely unknown, but many authoritative textbooks describe a high incidence of respiratory complications.

Laparoscopic stereoscopic augmented reality: toward a clinically viable electromagnetic tracking solution.

The purpose of this work was to develop a clinically viable laparoscopic augmented reality (AR) system employing stereoscopic (3-D) vision, laparoscopic ultrasound (LUS), and electromagnetic (EM) tracking to achieve image registration. We investigated clinically feasible solutions to mount the EM sensors on the 3-D laparoscope and the LUS probe. This led to a solution of integrating an externally attached EM sensor near the imaging tip of the LUS probe, only slightly increasing the overall diameter of the probe.

A Study of VITOM in Pediatric Surgery and Urology: Evaluation of Technology Acceptance and Usability by Operating Team and Surgeon Musculoskeletal Discomfort.

Introduction: We studied operating team acceptability of Video Telescopic Monitor (VITOM) exoscope by exploring the ease of use of the device in two centers. We also assessed factors affecting surgeon musculoskeletal discomfort.

Methods: We focused on how the operating team interacted with the VITOM system with surrogate measures of usefulness, image quality, ease of use, workload, and setup time.

Surgical management of esophageal achalasia: Evolution of an institutional approach to minimally invasive repair.

Background: Surgical management of esophageal achalasia (EA) in children has transitioned over the past 2 decades to predominantly involve laparoscopic Heller myotomy (LHM) or minimally invasive surgery (MIS). More recently, peroral endoscopic myotomy (POEM) has been utilized to treat achalasia in children. Since the overall experience with surgical management of EA is contingent upon disease incidence and surgeon experience, the aim of this study is to report a single institutional contemporary experience for outcomes of surgical treatment of EA by LHM and POEM, with regards to other comparable series in children.

Laparoscopic Gastrostomy Is Superior to Percutaneous Endoscopic Gastrostomy Tube Placement in Children Less Than 5 years of Age.

Purpose: Minimally invasive procedures for enteral access in children have evolved over the years, resulting in various techniques of gastrostomy tube placement. The two most common techniques are laparoscopic gastrostomy (LG) and percutaneous endoscopic gastrostomy (PEG). Our study compares the outcomes of both procedures exclusively in children under the age of five.

On-demand calibration and evaluation for electromagnetically tracked laparoscope in augmented reality visualization.

Purpose: Common camera calibration methods employed in current laparoscopic augmented reality systems require the acquisition of multiple images of an entire checkerboard pattern from various poses. This lengthy procedure prevents performing laparoscope calibration in the operating room (OR). The purpose of this work was to develop a fast calibration method for electromagnetically (EM) tracked laparoscopes, such that the calibration can be performed in the OR on demand.

Conservative Treatment of Lung Perforation Secondary to Retained Catheter in an Extremely Low-Birth-Weight Premature Infant.

Airway injury may occur during the use of any instrumentation in premature infants. A surgical approach for the treatment of lung perforation in extremely low-birth-weight infants has been recommended in the past. Here, we present a case of lung perforation in an ex-28-week, 730-g premature infant, who sustained lung perforation, secondary to an 8-Fr suction catheter used to administer surfactant, in which the broken catheter was retained in the airway.

Minimally invasive percutaneous pericardial ICD placement in an infant piglet model: Head-to-head comparison with an open surgical thoracotomy approach.

Background: Epicardial implantable cardioverter-defibrillator (ICD) placement in infants, children, and patients with complex cardiac anatomy requires an open surgical thoracotomy and is associated with increased pain, longer length of stay, and higher cost.

Objective: The purpose of this study was to compare an open surgical epicardial placement approach with percutaneous pericardial placement of an ICD lead system in an infant piglet model.

Methods: Animals underwent either epicardial placement by direct suture fixation through a left thoracotomy or minimally invasive pericardial placement with thoracoscopic visualization.

Evaluating the impact of a minimally invasive pediatric surgeon on hospital practice: comparison of two children's hospitals.

Purpose: Widespread adoption of minimally invasive surgery (MIS) techniques in pediatric surgery has progressed slowly, and the shift in practice patterns has been variable among surgeons. We hypothesized that a pediatric surgeon committed to MIS could effectively change surgical practice by creating an emphasis on MIS.

Methods: Annual case volumes from 2000 to 2009 at two tertiary care pediatric hospitals, one with a dedicated minimally invasive pediatric surgeon, were evaluated for trends in MIS for ten different operations.

Application of single-image camera calibration for ultrasound augmented laparoscopic visualization.

Accurate calibration of laparoscopic cameras is essential for enabling many surgical visualization and navigation technologies such as the ultrasound-augmented visualization system that we have developed for laparoscopic surgery. In addition to accuracy and robustness, there is a practical need for a fast and easy camera calibration method that can be performed on demand in the operating room (OR). Conventional camera calibration methods are not suitable for the OR use because they are lengthy and tedious.

Advances in minimally invasive surgery in pediatric patients.

Surgery has changed dramatically over the last several decades. The emergence of MIS has allowed pediatric surgeons to manage critically ill neonates, children, and adolescents with improved outcomes in pain, postoperative course, cosmesis, and return to normal activity. Procedures that were once thought to be too difficult to attempt or even contraindicated in pediatric patients in many instances are now the standard of care.

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management.

Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry.