Lessons Learned After 101 Cases of Single-Site Magnetic-Assisted Cholecystectomy in Children.

BACKGROUND / PURPOSE: The aim of this report is to present our experience with a magnetic-assisted single-site cholecystectomy technique ("magnachole") in pediatric patients. METHODS: We performed a retrospective chart review of all patients who underwent magnachole between 2009 and 2019. We evaluated patients' demographics, diagnosis, operative time, complications, conversion rate and length of stay. Additionally, simple lineal regression analysis was conducted to determine if the surgeon's experience, the patient's age at surgery, the patient's gender or the patient's body weight affected operative time. RESULTS: A total of 101 patients were operated during the analyzed period. The mean age at surgery was 12.6 (range 4 to 19) years, and the mean body weight was 53.7 (range 13.5 to 123) kg. The most frequent indication (91%) was symptomatic cholelithiasis. Mean operative time was 85 (range 45 to 240) min. The mean operative time decreased by 22.7 min (p < 0.001, 95% [CI] 10.35 to 35.13) when we compared the first 51 cases to the last 50 cases. Simple lineal regression showed a reduction of 2.6 min in operative time per year. Age at surgery, gender, and weight did not influence operative time. There were no intraoperative complications. Only 1 case required an additional port to complete the operation. There were no conversions to open cholecystectomy. Median length of stay was 26 h (range 10 to 168). CONCLUSION: The magnachole technique is safe and effective, and has become our preferred surgical approach for children who need a cholecystectomy. As expected, the operative time decreased as surgeons gain experience with the technique. The technique is feasible regardless of the patient's body habitus. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level IV.

Changes in chest compression indexes with breathing underestimate surgical candidacy in patients with pectus excavatum: a computed tomography pilot study.

BACKGROUND: Haller Index (HI) ≥3.25 by computed tomography (CT) at end-inspiration has been used to indicate surgical correction in patients with pectus excavatum. However, chest wall diameters vary with breathing and may modify HI values and surgical indications. The aim of our study was to report the changes in HI with breathing and their impact in the surgical indication rates. METHODS: Thirty six patients with pectus excavatum underwent chest CT evaluation at both end-inspiration and end-expiration. HI was derived by dividing the transverse diameter (TD) of the chest by the anteroposterior diameter (APD). Cardiac compression index (CCI) was then calculated by dividing the cardiac TD by the APD. RESULTS: Mean patient age was 19 ± 7 years old and 86.8% were males. From end-inspiration to end-expiration, large changes in APD values corresponded to large changes (29.6%) in HI values. CCI increased significantly during end-expiration, primarily driven by an increase on the cardiac TD. Surgical indication was found in 71% and 91% of patients during end-inspiration and end-expiration, respectively (p<0.05). CONCLUSIONS: This study showed that the severity indexes of the pectus excavatum were all significantly more severe at end-expiration than at end-inspiration, leading to an increase in surgical candidacy. We therefore recommend performing the CT at end-expiration.

Novel hybrid (magnet plus curve grasper) technique during transumbilical cholecystectomy: initial experience of a promising approach.

OBJECTIVES: The use of magnets in transumbilical cholecystectomy (TUC) improves triangulation and achieves an optimal critical view. Nonetheless, the tendency of the magnets to collide hinders the process. In order to simplify the surgical technique, we developed a hybrid model with a single magnet and a curved grasper. PATIENTS AND METHODS: All TUCs performed with a hybrid strategy in our pediatric population between September 2009 and July 2012 were retrospectively reviewed. Of 260 surgical procedures in which at least one magnet was used, 87 were TUCs. Of those, 62 were hybrid: 33 in adults and 29 in pediatric patients. The technique combines a magnet and a curved grasper. Through a transumbilical incision, we placed a 12-mm trocar and another flexible 5-mm trocar. The laparoscope with the working channel used the 12-mm trocar. The magnetic grasper was introduced to the abdominal cavity using the working channel to provide cephalic retraction of the gallbladder fundus. Across the flexible trocar, the assistant manipulated the curved grasper to mobilize the infundibulum. The surgeon operated through the working channel of the laparoscope. RESULTS: In this pediatric population, the mean age was 14 years (range, 4-17 years), and mean weight was 50 kg (range, 18-90 kg); 65% were girls. Mean operative time was 62 minutes. All procedures achieved a critical view of safety with no instrumental collision. There were no intraoperative or postoperative complications. The hospital stay was 1.4±0.6 days, and the median follow-up was 201 days. CONCLUSIONS: A hybrid technique, combining magnets and a curved grasper, simplifies transumbilical surgery. It seems feasible and safe for TUC and potentially reproducible.