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Biomedical subjects

Steven S Rothenberg

Publications and source records attributed to Steven S Rothenberg.

12 recordsLinked to original sources
PubMed2006

Current concepts in surgical management of pediatric lung and chest wall diseases.

PURPOSE OF REVIEW: The management of pediatric lung and chest wall diseases has changed dramatically in the last decade because of the application of minimally invasive surgical techniques. This review will try to highlight some of the more significant recent contributions. RECENT FINDINGS: Most of the papers quoted will show that the application of minimally invasive surgery to the treatment of common problems such as empyema, pneumothorax, and lung biopsy has significantly altered our treatment algorithms, because of decreased morbidity and improved outcomes compared to standard surgical or medical treatment plans. This has also been true for pediatric chest wall deformities, which previously were treated in only the most severe cases and thought to be mostly cosmetic in nature. More recent reports now show statistically significant improvements in cardio-pulmonary physiology as well as quality of life. SUMMARY: The application of less invasive surgical procedures for lung and chest wall diseases has warranted earlier intervention, with better outcomes, and less morbidity than previously used techniques. A clear understanding of these techniques and their benefits is important for the referring and treating physician as previously used treatment protocols may no longer provide the best patient care.

Biopsy↗
PubMed2005

The first decade's experience with laparoscopic Nissen fundoplication in infants and children.

BACKGROUND/PURPOSE: Fundoplication for gastroesophageal reflux disease is a common procedure performed in infants and children. This report describes over a 10-year experience with more than 1000 consecutive laparoscopic Nissen fundoplications. METHODS: Ages ranged from 5 days to 18 years and weight from 1.2 to 120 kg. The procedures were performed using a 5 trocar technique and with 5- or 3-mm instruments depending on the size of the patient. Of 1050 fundoplications, 1048 were completed successfully through laparoscopy. RESULTS: Average operative time dropped dramatically from 109 minutes for the first 30 cases compared with 38 minutes for the last 30. Intraoperative and postoperative complications were 0.26% and 4.0%, respectively. Average time to discharge post fundoplication was 1.1 days. The wrap failure rate is 4.0%. CONCLUSIONS: This study shows in a large operative experience for 10 years that laparoscopic fundoplication is safe and effective in the pediatric population. Clinical results are comparable to the traditional open fundoplication but with a significant decrease in morbidity and hospitalization.

Adolescent↗
PubMed2005

Thoracoscopic repair of esophageal atresia and tracheo-esophageal fistula.

Advancements in minimally invasive surgical techniques and instruments for neonates have allowed even the most complex neonatal procedures to be approached endoscopically. In 1998 the first successful thoracoscopic repair of an esophageal atresia was performed in a 2-month-old infant. One year later the first totally thoracoscopic repair of an atresia with distal fistula was realized. Over the ensuing 5 years these techniques have become more refined and widespread so that this technique is now being performed all over the world with excellent results, while avoiding the significant short- and long-term morbidity associated with thoracotomy in neonates.

Anastomosis, Surgical↗
PubMed2005

Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis.

OBJECTIVES: For the past 60 years, successful repair of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) has been performed via a thoracotomy. However, a number of reports have described adverse musculoskeletal sequelae following thoracotomy in infants and young children. Until now, only a few scattered case reports have detailed an individual surgeon's success with thoracoscopic repair of EA/TEF. This multi-institutional review represents the largest experience describing the results with this approach. METHODS: A cohort of international pediatric surgeons from centers that perform advanced laparoscopic and thoracoscopic operations in infants and children retrospectively reviewed their data on primary thoracoscopic repair in 104 newborns with EA/TEF. Newborns with EA without a distal TEF or those with an isolated TEF without EA were excluded. RESULTS: In these 104 patients, the mean age at operation was 1.2 days (+/-1.1), the mean weight was 2.6 kg (+/-0.5), the mean operative time was 129.9 minutes (+/-55.5), the mean days of mechanical ventilation were 3.6 (+/-5.8), and the mean days of total hospitalization were 18.1 (+/-18.6). Twelve (11.5%) infants developed an early leak or stricture at the anastomosis and 33 (31.7%) required esophageal dilatation at least once. Five operations (4.8%) were converted to an open thoracotomy and one was staged due to a long gap between the 2 esophageal segments. Twenty-five newborns (24.0%) later required a laparoscopic fundoplication. A recurrent fistula between the esophagus and trachea developed in 2 infants (1.9%). A number of other operations were required in these patients, including imperforate anus repair in 10 patients (7 high, 3 low), aortopexy (7), laparoscopic duodenal atresia repair (4), and various major cardiac operations (5). Three patients died, one related to the EA/TEF on the 20th postoperative day. CONCLUSIONS: The thoracoscopic repair of EA/TEF represents a natural evolution in the operative correction of this complicated congenital anomaly and can be safely performed by experienced endoscopic surgeons. The results presented are comparable to previous reports of babies undergoing repair through a thoracotomy. Based on the associated musculoskeletal problems following thoracotomy, there will likely be long-term benefits for babies with this anomaly undergoing the thoracoscopic repair.

Cohort Studies↗
PubMed2003

Experience with thoracoscopic lobectomy in infants and children.

PURPOSE: This study evaluates the safety and efficacy of thoracoscopic lobectomy in infants and children. METHODS: From January 1995 to May 2002, 45 patients underwent video-assisted thoracoscopic lobe resection. Ages ranged from 2 days to 18 years and weights from 2.8 to 78 kg. Preoperative diagnosis included sequestration/congenital adenomatoid malformation (n = 28), severe bronchiectasis (n = 12), congenital lobar emphysema (n = 3), and malignancy (n = 2). RESULTS: Forty-three of 45 procedures were completed thoracoscopically. Operating times ranged from 35 minutes to 210 minutes (average, 125 minutes). There were 6 upper, one middle, and 38 lower lobe resections. There was one intraoperative complication (2.4%) requiring conversion to an open thoracotomy. Chest tubes were left in 38 of 45 patients for 1 to 3 days. Hospital stay ranged from 1 to 5 days (average 2.4). CONCLUSIONS: Thoracoscopic lung resection is a safe and efficacious technique. It helps avoid the inherent morbidity of a major thoracotomy incision and is associated with the same decrease in postoperative pain, recovery, and hospital stay as seen in minimally invasive procedures.

Adolescent↗
PubMed2002

Thoracoscopic repair of tracheoesophageal fistula in newborns.

BACKGROUND: Advancements in minimally invasive surgery in neonates have allowed even the most complex neonatal procedures to be approached using these techniques. METHODS: During a period of 15 months, 8 patients born with a proximal esophageal atresia and a distal tracheoesophageal fistula underwent repair thoracoscopically. Weights ranged from 2.1 to 3.4 kg and operating times ranged from 55 to 120 minutes. RESULTS: All procedures were completed successfully thoracoscopically, and there were no operative complications. One patient had a small leak on day 4 that resolved spontaneously on day 8. All other patients were shown to have a patent anastomosis with no leak by Barium swallow on day 5. CONCLUSION: This initial report shows that esophageal repair in the neonate is technically feasible and may provide advantages in terms of exposure and esophageal length, as well as the recognized advantages of avoiding a thoracotomy.

Feasibility Studies↗
PubMed2002

Laparoscopic duodenoduodenostomy for duodenal obstruction in infants and children.

BACKGROUND/PURPOSE: Duodenal obstruction, such as that resulting from atresia or web, routinely has been corrected by laparotomy and duodenoduodenostomy. Until recently, no one has reported on the use of minimally invasive techniques to correct this congenital anomaly. Over the last 6 months we have approached 4 patients, 3 with atresia and one with a web, laparoscopically. Three were newborns, and one was 8 months old. METHODS: All procedures were performed with 3-mm instruments and scopes. RESULTS: Operating time in all cases was less then 90 minutes. Visualization was excellent, and there were no intraoperative complications. Feedings were started on postoperative day 5 in all 3 neonates and day 3 in the infant. All 4 were on full feedings after 3 days. Follow-up upper gastrointestinal tests show no evidence of stricture or obstruction. CONCLUSION: Laparoscopy provides an excellent way to evaluate and treat congenital duodenal obstruction.

Duodenal Obstruction↗
PubMed2002

Laparoscopic segmental intestinal resection.

There are numerous disease processes in the pediatric population that require segmental intestinal resection with primary anastomosis. These include intestinal strictures from necrotizing enterocolitis in neonates, resection of congenital lesions such as a Meckel's diverticulum or intestinal webs, and strictures from inflammatory bowel disease. Whereas the treatment of these lesions previously required a major laparotomy, they now can be approached using a minimally invasive surgical (MIS) approach. Techniques from laparoscopic intestinal mobilization with extracorporeal resection and anastomosis to complete intracorporeal resection and anastomosis have been successfully developed for pediatric patients. The benefits are similar to those achieved from other laparoscopic procedures and include decreased postoperative pain and morbidity, reduced postoperative hospitalization and faster return to normal activity. Early experience suggests that the minimally invasive approach is acceptable and, perhaps, favorable in the treatment of segmental intestinal disease in infants and children.

Adolescent↗
PubMed2002

Laparoscopic Nissen procedure in children.

Fundoplication is among the most frequently performed procedures in infants and children. The Nissen fundoplication is the most commonly performed anti-reflux procedure done in the pediatric population. The broad indications include respiratory compromise, failure to thrive, neurologic impairment, and severe esophagitis. Over the last decade the application of a minimally invasive surgical technique to this procedure has received widespread acceptance among adult and pediatric surgeons and should now be considered the technique of choice.

Child↗
PubMedDate not supplied

Thoracoscopic surgery in childhood cancer.

PURPOSE: Recent advances in minimally invasive surgery, especially thoracoscopy, have allowed many new applications in children. The authors' purpose was to review their experience with thoracoscopic surgery in childhood cancer. They hypothesized that thoracoscopy can be efficacious, safe, and cost-effective and has the potential to change the way we care for children with cancer. PATIENTS AND METHODS: The authors reviewed their thoracoscopic experience of the past 7 years. Thoracoscopic procedures performed included biopsy and resection of masses, resection of lung nodules, biopsy of infiltrates, and lobectomy. Some resections required conversion to open thoracotomy. RESULTS: Sixty-three thoracoscopic procedures were performed on 52 children; 8 required conversion to open thoracotomy and 55 were completed by thoracoscopy alone. The overall success rate was 98.4%. There were three complications and no deaths. The mean surgery time was 1.2 hours, mean length of hospital stay was 1.9 days, and mean number of chest tube days was 0.7. CONCLUSIONS: Thoracoscopic surgery in the treatment of children with cancer can be efficacious, safe, and cost-effective. Mediastinal masses can usually be biopsied and resected by thoracoscopy alone. Conversion to open thoracotomy for a more complete resection can be safely accomplished if needed. Thoracoscopic removal of lung nodules allows more accurate staging and early initiation of chemotherapy. Thoracoscopic biopsy of lung infiltrates can be safely performed in intubated, critically ill children and changed the treatment in all of these patients. Surgery time and days in hospital were decreased compared with historical thoracotomy data.

Adolescent↗