ABSTRACT
Purpose: Robotic surgery (RS) has the advantages of 3-dimensional view, optical magnification, motional scaling, and improved ergonomics and degree of freedom. Although RS has widely been performed on pediatric patients lately, there are still numerous restrictions and ambiguous indications. The purpose of this study was to report our early experience with RS on pediatric patients at a single center. Methods: Electronic medical records of patients who underwent RS with the da Vinci Xi surgical platform (Intuitive Surgical, Inc.) in Seoul National University Children Hospital from November 2019 to August 2021 were reviewed retrospectively. The median follow-up was 21.0 months (range, 12.3-31.8 months). An online survey was conducted to investigate satisfaction with robotic surgical scars. Results: Fifty-four patients underwent robotic surgeries (median age at operation, 11.1 years [range, 0.1-17.8 years]). In our hospital, patients had 20 different kinds of robotic surgeries, including choledochal cyst excision with hepaticojejunostomy, ovarian mass excision, and others. Median operation time and console time were 157.5 minutes (range, 45-505 minutes) and 40 minutes (range, 11-360 minutes), respectively. All cases were done without conversion into open or laparoscopic methods. Postoperative complications were found in 5 patients. According to an online survey, over half of patients (60.9%) answered that they felt satisfied with scars. Conclusion: Our early experience demonstrated the safety and feasibility of RS in children with a range of diagnoses and complicated procedures. With more experience, RS could be an alternative to traditional open or laparoscopic operations in pediatric patients. Further studies are needed to clarify indications of pediatric RS.
ABSTRACT
Bacillus Calmette-Guerin (BCG) vaccination can cause lymphadenitis. The purpose of the current study was to describe patient characteristics and clinical courses of lymphadenitis associated with BCG vaccination. A total of 171 patients who visited a tertiary hospital with a diagnosis of BCG-associated lymphadenitis between January 2012 and June 2017 were included. The diagnostic criteria were a history of BCG vaccination on the symptomatic side, absence of tenderness and raised temperature over the swelling, absence of fever and constitutional symptoms, and isolated axillary (or supraclavicular/cervical) lymph node (LN) enlargement. Treatment strategies included observation, antibiotics, incision and drainage or needle aspiration (I&D/NA), and surgical excision. The median follow-up period was 40 days (range 1−1245 days). The median age at the first visit was 5.5 months (range 0.9−83.7 months). The most common location was the axilla (81.3%). The respective numbers of patients managed via observation, I&D/NA, antibiotics, and surgical excision were 99, 47, 5, and 20. LNs were significantly more enlarged in the I&D/NA group than in the antibiotics group and the observation group. The respective times taken for residual lesions to reduce to < 20% were approximately 3 months, 4 months, and 5 months in the antibiotics, observation, and I&D/NA groups. The surgery group had significantly fewer residual lesions than the observation group at the last visit, but there was no significant difference in current residual lesions between the groups. LNs were significantly larger in the I&D/NA group. The surgery group exhibited the least residual lesions at the last visit, but there was no significant difference in current status.
ABSTRACT
(1) Background: Necrotizing enterocolitis (NEC) is one of the leading causes of death in newborns despite improvements in the care of critically ill neonates. Approximately 50-70% of the cases are managed by medical therapy. However, the remaining patients require surgical intervention. The purpose of our study was to analyze the factors associated with patients requiring surgical treatment compared to patients requiring only medical treatment; (2) Method: Patients diagnosed with necrotizing enterocolitis over a period of 14 years (January 2003-December 2016) in a single tertiary referral children's hospital were retrospectively enrolled. Demographics and clinical data were collected through the medical record and were analyzed using Pearson's χ2 test, t-tests, and linear regression; (3) Results: A total of 189 NEC patients were analyzed. In the surgical NEC group, gestational age was lower (p = 0.018), body weight at birth was lower (p = 0.034), comorbidity with respiratory distress syndrome (RDS) was higher (p = 0.005), the days of antibiotic use were greater (p = 0.014), the percentage of breast milk feeding was lower (p = 0.001), and the length of hospital stay was longer (p < 0.000). The in-hospital mortality between the two groups was not significantly different (p = 0.196). In multivariate logistic analysis, breast milk feeding remained less associated with surgical NEC (OR = 0.366, 95% CI: 0.164-0.817), whereas the length of hospital stay was more associated with surgical NEC (OR = 1.010, 95% CI: 1.001-1.019); (4) Conclusion: Comparing medical and surgical NEC, a significantly lower percentage of surgical NEC patients were fed breast milk and their hospital stays were longer.
