Comparison of Postoperative Outcomes of Open, Laparoscopic, and Robotic Surgery for Pediatric Choledochal Cyst Excision.

Background: Choledochal cyst is treated with extrahepatic bile duct resection and hepaticojejunostomy. Minimally invasive approaches, including laparoscopic surgery (LS) and robotic surgery (RS), offer potential advantages over open surgery (OS), but their impact on perioperative and short-term postoperative outcomes remains unclear.

Methods: This retrospective study analyzed 201 pediatric patients who underwent OS (n=83), LS (n=89), or RS (n=29).

Thoracoscopic Posterior Tracheopexy After Esophageal Atresia Repair: A Case Report.

Esophageal atresia (EA) is frequently associated with tracheomalacia (TM). Recently, the use of posterior tracheopexy (PT) during EA repair for addressing TM has gained attention. Herein, we report a case of thoracoscopic PT in a 6-year-old boy with EA.

Preoperative classification based on intrahepatic bile duct morphology for predicting postoperative complications in congenital biliary dilatation.

Background: Late postoperative complications of congenital biliary dilatation include intrahepatic bile duct stones, cholangitis, and cholangiocarcinoma. This study aimed to establish a preoperative classification system using intrahepatic bile duct morphology and evaluate its effectiveness in predicting postoperative complications.

Methods: This retrospective study reviewed 196 patients who underwent radical congenital biliary dilatation surgery between 2003 and 2022.

Emergency One-Stage Robotic Surgery for Congenital Biliary Dilatation With Bile Duct Perforation in a Pediatric Patient: A Case Report.

Bile duct perforation is a rare, serious complication of congenital biliary dilatation (CBD). While traditionally managed with a two-stage surgical approach, recent reports suggest that one-stage, minimally invasive approaches may be feasible. We present the case of a 13-month-old female who developed bile duct perforation associated with a protein plug in the common channel.

Strategy of reduced port gastrostomy as a safe procedure for paediatric patients.

Background: Laparoscopic gastrostomy has improved surgical and cosmetic outcomes. Our approach involves a strategy of reduced port surgery, wherein only the umbilicus and tube insertion site were incised, with an additional port inserted if manipulation is difficult. This study aimed to investigate the outcomes of our reduced port gastrostomy strategy.

Learning curve comparison of robot-assisted and laparoscopic hepaticojejunostomy: a focus on critical suturing.

Background: Robot-assisted surgery (RS) has gained popularity due to its potential advantages over conventional laparoscopic surgery (LS). However, the specific suturing steps that benefit most from RS in terms of efficiency remain unclear. This study aimed to compare the suturing performance and learning curves of RS and LS during hepaticojejunostomy.

Young pediatric surgeons without endoscopic surgical skill qualification safely perform advanced endoscopic surgery under the supervision of expert qualified surgeons.

Background: Young pediatric surgeons should receive adequate training in various minimally invasive surgeries (MIS). However, it is essential to maintain patient safety and outcomes during the learning process. In Japan, the endoscopic surgical skill qualification (ESSQ) system in pediatric surgery was initiated by the Japan Society for Endoscopic Surgery (JSES) in 2009 to objectively evaluate the skill of endoscopic surgeons.

Evaluation of the risk factors for postoperative pectus excavatum and scoliosis in cystic lung disease.

Purpose: To analyze the frequency and predictive factors of the development of postoperative pectus excavatum and scoliosis in children who underwent surgery for cystic lung disease.

Methods: This study examined patients who underwent surgery for cystic lung disease (open and thoracoscopic) between July 2000 and December 2018 with a > 3-year follow-up period. Lesion size, surgical outcomes, and subsequent musculoskeletal complications were compared between the open surgery and thoracoscopic surgery groups.

Usefulness of lateral-anteroposterior dimeter ratio in patients with tracheomalacia associated with esophageal atresia.

Purpose: Tracheomalacia (TM) is commonly associated with esophageal atresia (EA) and compression by the brachiocephalic artery is a factor for TM. Previous research has focused on the lateral-to-anteroposterior tracheal diameter ratio (LAR). This study aimed to assess the LAR and postoperative outcomes of EA patients.

Characteristics and outcomes of minimally invasive surgery for congenital biliary dilatation in children aged <6 years: Comparison between children and adults.

Background/purpose: We evaluated the minimally invasive surgery for congenital biliary dilatation (CBD) in adults and children and analyzed the surgical outcomes, especially in children aged <6 years.

Methods: Characteristics and surgical outcomes of patients with CBD who underwent minimally invasive surgery at our hospital between 2013 and 2023 were retrospectively reviewed.

Results: Overall, 129 patients (89 children aged <6 years, 9 children aged between 6 and 18 years, and 21 adults) were included in this study.

Developing an Effective Off-the-job Training Model and an Automated Evaluation System for Thoracoscopic Esophageal Atresia Surgery.

Background: Pediatric minimally invasive surgery requires advanced technical skills. Off-the-job training (OJT), especially when using disease-specific models, is an effective method of acquiring surgical skills. To achieve effective OJT, it is necessary to provide objective and appropriate skill assessment feedback to trainees.

Preoperative management comprising tube irrigation using a trans-anal indwelling tube for infants with hirschsprung disease can allow single-stage radical surgery.

Background: Preoperative management of Hirschsprung's disease (HD) is currently being conducted with the goal of performing single-stage radical surgery without ileostomy.

Methods: We retrospectively reviewed HD cases between 2013 and 2022, as well as their outcomes related to preoperative management.

Results: Thirty-nine patients with HD were included in this study, including short-segment HD (30 cases), long-segment HD (4 cases), and total colonic aganglionosis (5 cases).

Anastomotic time was associated with postoperative complications: a cumulative sum analysis of thoracoscopic repair of tracheoesophageal fistula in a single surgeon's experience.

Purpose: This study aimed to evaluate the learning curve of thoracoscopic repair of tracheoesophageal fistula (TEF) by a single surgeon using a cumulative sum (CUSUM) analysis.

Methods: Prospective clinical data of consecutive Gross type-C TEF repairs performed by a pediatric surgeon from 2010 to 2020 were recorded. CUSUM charts for anastomosis and operating times were generated.

Update on aortopexy and posterior tracheopexy for tracheomalacia in patients with esophageal atresia.

Despite improving the survival after repair of esophageal atresia (EA), the morbidity of EA repair remains high. Specifically, tracheomalacia (TM) is one of the most frequent complications of EA repair. Continuous positive airway pressure is generally applied for the treatment of TM.