Mari Arai

Endosurgical procedures for pediatric solid tumors

The aim of this study was to evaluate the advantages and complications of endosurgical procedures for benign and malignant pediatric solid tumors. Endosurgical techniques of biopsy and excision were used for diagnosis and treatment of solid tumors, respectively. Since July 1997, a total of 24 biopsies and 24 excisions have been performed laparoscopically for neuroblastoma (n=24), ovarian solid tumors (n=10) and other tumors. Seventeen biopsies and six excisions were performed for abdominal neuroblastoma, while ten excisions were performed for ovarian tumor. In these patients, the length of the operation, blood loss, time to start postoperative feeding, time to start postoperative chemotherapy and length of hospital stay were evaluated and compared to the those of the open surgery group. Furthermore, intra- and postoperative complications were analyzed in all patients of both groups. The length of the hospital stay and time to start postoperative feeding were significantly shorter in the group of patients who underwent endosurgical procedures for either abdominal neuroblastoma or ovarian tumor when compared to the open procedure group. The time to start postoperative chemotherapy was shorter only in the abdominal neuroblastoma group. The procedure for two patients undergoing endosurgical tumor excision had to be converted to open surgery due to large tumor size. Two weeks after thoracoscopic excision of a dumb bell-type neurofibroma, one patient underwent open repair of the dura mater because of leakage of cerebrospinal fluid. There were no port-site recurrences in any tumor types. Endosurgical procedures for solid tumors are effective and minimally invasive. However, better indicators are needed for their implementation in order to prevent complications and subsequent conversions to open procedures.

No incidence of port-site recurrence after endosurgical procedure for pediatric malignancies.

Port-site recurrence (PSR) following laparoscopic procedures has been an unpredictable complication in adult cancer patients; however, no data exist about this phenomenon in the pediatric field. The aim of this study was to determine whether PSR, following endosurgical procedure for malignancies, is a typical complication or a rare event in the pediatric population. Eighty-one questionnaires were mailed to members of The Japanese Society of Pediatric Endosurgeons. They were asked to provide a list of their institutions that had experience with PSR after endosurgical procedures for pediatric malignancies. Among 29 institutions, a total of 129 endosurgical procedures for pediatric malignancies were reported; these included 85 laparoscopic and 44 thoracoscopic procedures, performed on 104 neuroblastomas, 8 hepatoblastomas, 7 nephroblastomas, and 10 other tumors. Of the 104 neuroblastomas, 83 were found by mass screening using high levels of urinary vanillylmandelic acid and homovanillic acid. Sixty-five of the 83 patients had their tumor excised, and 18 had their tumor biopsied by endosurgical procedures. Additionally, 47 of these patients did not require any postoperative chemotherapy. No incidence of PSR was reported in any of the patients that underwent endosurgical procedures. The PSR following endosurgical procedure is a rare phenomenon in the pediatric population. Both, laparoscopic and thoracoscopic procedures, are safe and recommended for treating pediatric malignancies, especially mass-screened neuroblastomas.

Laparoscopic surgery in neonates and infants weighing less than 5 kg

Background : Laparoscopic surgery in small infants is still an uncommon procedure in Japan. The present study was conducted to evaluate the advantages and disadvantages of laparoscopic surgery in neonates and infants weighing less than 5 kg.

Laparoscopically Assisted Anorectal Pull-Through for Rectocloacal Fistula

Successful laparoscopically assisted anorectal pull-through combined with simultaneous posterior skin flap vaginoplasty is reported. Case Report: A 13-month-old girl who underwent initial sigmoidostomy at birth presented with a rectocloacal anomaly: a double vagina and intermediate confluence of the urogenital sinus with a high type of rectovaginal fistula. She simultaneously underwent a laparoscopically assisted anorectal pull-through and a posterior skin flap vaginoplasty. After vaginoplasty, the distal rectum was laparoscopically dissected and the rectovaginal fistula was divided. A laparoscopic muscle stimulator 5 mm in diameter showed good contraction of the levator muscles in the pelvic floor. With laparoscopic visualization, a guidewire and a balloon catheter were inserted into the center of the levator muscle sling and muscle complex, and dilation of the pull-through tract was achieved. Rectal pull-through and anastomosis between the rectum and anus were successfully completed. The operation took ...

Efficacy of Laparoscopic Surgery Combined with Intraoperative Fluoroscopy in Children

A 9-month-old girl weighing 6.2 kg with a chief sign of vomiting underwent laparoscopic gastropexy for gastric volvulus. Intraoperative fluoroscopy revealed the shape of the whole stomach and demonstrated that the most suitable site for gastropexy was between the anterior abdominal wall and the stomach. A 3-year-old boy weighing 15 kg had an asymptomatic intra-abdominal foreign body for 6 months. Abdominal radiography and CT showed a radiopaque foreign body in what seemed like a Meckels diverticulum or the appendix. Laparoscopic observation combined with intraoperative fluoroscopy illustrated an intra-appendiceal foreign body, the tip of a metal toy. Its complete removal by laparoscopic appendectomy confirmed the accuracy of the diagnosis. Intraoperative fluorescopy during laparoscopic surgery is a very useful tool for correct diagnosis and treatment.

Laparoscopic Pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis

Purpose: To evaluate the advantages and disadvantages of laparoscopic pyloromyotomy (LP) compared to the open conventional right upper-quadrant approach for pyloromyotomy (RP), and the umbilical approach for pyloromyotomy (UP). Methods: Clinical records of 175 RP (1983-1994), 71 UP (1994-1997), and 98 LP (1997-2002) were evaluated retrospectively. Weight at birth, age and weight at surgery, blood base excess (BE) on admission, length of operation, complications, and post-operative length of stay were compared among the groups. Results: There were no significant differences in either age or weight among the three groups. The length of operation in the RP group was 29 ± 8 min, which was significantly shorter than that in the UP (40 ± 10 min) and LP (41 ± 14 min) groups. The average length of operation in LP for each surgeon decreased once the surgeon had performed more than 5 LPs. Length of stay was significantly shorter in LP (4.3 ± 1.1 days) than in RP (8.3 ± 4.0 days) and UP (8.7 ± 7.8 days). There were ...

Extrahepatic portal vein obstruction in a neonate

frequent causes of portal hypertension in children. Although the etiology of portal obstruction is unclear, tortuous collateral vessels gradually develop around the blocked portal vein, generating cavernous transformation. Most of these cases subsequently suffer from variceal hemorrhage and/or splenomegaly. Asymptomatic portal obstruction generally goes undetected. Herein, we report a chance diagnosis of portal venous obstruction via ultrasound in a neonate.

Laparoscopic Resection of Pulmonary Sequestration in an Infant with Congenital Diaphragmatic Hernia

Laparoscopic repair (LR) of late-onset congenital diaphragmatic hernia (CDH) is not a common procedure in infants. We report a successful LR of a left CDH combined with laparoscopic resection of an extralobar pulmonary sequestration. A 4-month-old infant was incidentally diagnosed with left CDH from a chest x-ray. After detailed imaging studies, LR was performed with one optical trocar and three working trocars. Laparoscopy revealed a left CDH with a sac and intestinal herniation. Subsequently, the hernia contents were reduced and the hernia sac was excised by laparoscopic coagulation shears. Laparoscopy also revealed an extralobar pulmonary sequestration and a small lung in the left thoracic cavity. The sequestration was resected using a GIA stapler, and the defects of the diaphragm were directly sutured using nonabsorbable sutures. The patient had an uneventful recovery following a short hospital stay. Conclusion: The laparoscopic approach can be an effective and more advantageous alternative to laparot...