Complications and conversions of pediatric videosurgery |
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Authors: | C Esposito G Mattioli G L Monguzzi L Montinaro G Riccipetiotoni R Aceti M Messina C Pintus A Settimi G Esposito V Jasonni |
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Institution: | (1) Division of Pediatric Surgery, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy, Via T. Campanella 115, 88100 Catanzaro, Italy, IT;(2) Division of Pediatric Surgery, Gaslini Istitute, Genova, Italy, IT;(3) Division of Pediatric Surgery, Buzzi Hospital, Milan, Italy, IT;(4) Division of Pediatric Surgery, University, Bari, Italy, IT;(5) Division of Pediatric Surgery, Annunziata Hospital, Cosenza, Italy, IT;(6) Division of Pediatric Surgery, University, Siena, Italy, IT;(7) Division of Pediatric Surgery, Gemelli Hospital, Rome, Italy, IT;(8) Division of Pediatric Surgery, Federico II University, Naples, Italy, IT |
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Abstract: | Background: The aim of this study was to evaluate the incidence and management of complications of videosurgical procedures
that occurred during a 4-year period in eight Italian pediatric surgery centers. Methods: Between 1996 and 1999, 2305 videosurgical
procedures were performed in 11 centers of pediatric surgery. The data from 3 centers, for a total of 616 procedures, were
largely incomplete and were thus excluded from the study. We analyzed the data from 8 centers only, for a total of 1689 laparoscopic
or thoracoscopic operations on patients aged between 15 days and 16 years. The type of operations performed ranged from basic
videosurgical interventions, such as varicocelectomy and cryptorchidism, to advanced laparoscopic procedures, such as splenectomy,
total colectomy, and esophageal achalasia. Each patient's file was examined for any complications that may have occurred during
the surgical procedure and for a record of how these were managed. Results: We recorded 79 complications (4.6%) in our series.
In 57 cases (72.2%) the problem was solved by videosurgery. Twenty-two cases (27.8%) required conversion to open surgery.
There was no mortality in our series. At a maximum follow-up of 4 years, all children were alive and had no problems related
to the videosurgical complications. Conclusions: We believe that the routine use of open laparoscopy in pediatric patients
is a key factor to avoiding complications related to the Veress needle and blind introduction of the first trocar. Moreover,
the surgeon's laparoscopic experience, the correct indications for laparoscopic surgery, and the verification of the laparoscopic
equipment before surgery are also important rules to follow to reduce the incidence of complications. In the beginning, it
is preferable to have the assistance of an expert laparoscopic surgeon to decrease the complications related to the learning
curve period. |
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Keywords: | Laparoscopy Complications Children |
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