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In laparoscopy, the absence of ergonomics in the instruments affects the performance and efficiency of the surgeon, increasing the likelihood of developing musculoskeletal injuries. This article presents the development of a laparoscopic needle holder with an ergonomic handle and the experience in its use with surgeons in the intracorporeal suturing task. The handle of the laparoscopic needle holder consists of a semi-spherical piece that easily adapts to the palm of the surgeon's hand and improves the posture and ergonomics of the wrist, allowing the direct transmission of rotational movements around the longitudinal axis of the instrument towards the tip. Moreover, a spring-loaded mechanism allows the tip of the tool to be opened and closed in a normally closed configuration, with enough pressure to hold different surgical needles. Twenty-two pediatric surgery surgeons and residents, without upper extremity musculoskeletal disorders, participated in this study. Each participant performed the intracorporeal suturing task using two laparoscopic needle holders (conventional and with ergonomic handle) in a laparoscopic simulator. Motion data from both instruments were captured and the performance was assessed by means of 16 motion analysis parameters (MAPs). The performance of the residents improved markedly using the laparoscopic needle holder with ergonomic handle, obtaining statistically significant differences in 10 MAPs evaluated. The comparison of the results of each instrument showed that this ergonomic laparoscopic needle holder stood out over the conventional tool, improving psychomotor skills and the ability to control the angular position and rotational movements of the instrument on its own axis, indispensable for intracorporeal suturing. The innovative design of the laparoscopic needle holder with ergonomic handle allows for better transfer of rotational movements from the surgeon's hand directly with the longitudinal axis to the tip, reducing extreme wrist positions and excessive effort to open and close the tip of the instrument during intracorporeal suturing. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the novices' learning curves and proficiency level reached in laparoendoscopic single-site (LESS) surgery using three surgical training programs. Participants were randomly divided into three groups, who trained in a specific practice regimen for 12 days using a laparoscopic box simulator and three tasks. Group A trained in three stages using conventional laparoscopic surgery (CLS) with straight instruments, and LESS with straight and articulating instruments for four days each. Group B trained in two stages in LESS with straight and articulating instruments for six days each. Group C trained only in LESS with articulating instruments exclusively for all 12 days. Performance was registered daily during the 12 days to evaluate the participants' progress. Pre- and post-training analysis of the three groups showed significant differences in performance, denoting the significant improvement in their LESS skills, with no difference between the groups. Group C reached a high level of technical competence with their specific training program in LESS, obtaining a lower asymptote and slow learning rate. Specific training programs in LESS settings using articulated instruments showed a slower learning rate than the other programs but better proficiency in the technique with the best surgical performance. [ABSTRACT FROM AUTHOR]

Background. This article aims to present an innovative design of a steerable surgical instrument for conventional and single-site minimally invasive surgery (MIS), which improves the dexterity and maneuverability of the surgeon while offering a solution to the limitations of current tools. Methods. The steerable MIS instrument consists of a deflection structure with a curved sliding joints design that articulates the distal tip in two additional degrees of freedom (DoFs), relative to the instrument shaft, using transmission by cables. A passive ball-joint mechanism articulates the handle relative to the instrument shaft, improves wrist posture, and prevents collision of instrument handles during single-site MIS procedures. The two additional DoFs of the articulating tip are activated by a thumb-controlled device, using a joystick design mounted on the handle. This steerable MIS instrument was developed by additive manufacturing in a 3D printer using PLA polymer. Results. Prototype testing showed a maximum tip deflection of 60° in the left and right directions, with a total deflection of 120°. With the passive ball-joint fully offset, the steerable tip achieved a deflection of 90° for the right and 40° for the left direction, with a total deflection of 130°. Furthermore, the passive ball-joint mechanism in the handle obtained a maximum range of motion of 60°. Conclusions. This steerable MIS instrument concept offers an alternative to enhance the application fields of conventional and single-site MIS, increasing manual dexterity of the surgeon and the ability to reach narrow anatomies from other directions. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of Fetal Endoscopic Tracheal Occlusion (FETO) on neonatal survival in fetuses with left congenital diaphragmatic hernia (CDH) and moderate lung hypoplasia. Study Design: CDH fetuses with moderate pulmonary hypoplasia (observed/expected lung area to head ratio between 26% and 35%, or between 36% and 45% with liver herniation) were prospectively recruited. Included patients were matched to a control group who were ineligible for FETO. Primary outcomes were survival at 28 days, at discharge, and at 6 months of age, respectively. Results: 58 cases were recruited, 29 treated with FETO and 29 matched controls. Median gestational age (GA) at balloon placement and removal were 29.6 and 33.6 weeks, respectively. FETO group showed significantly lower GA at delivery (35.2 vs. 37.1 weeks, respectively, p < 0.01), higher survival at 28 days (51.7 vs. 24.1%, respectively, p = 0.03), at discharge (48.3 vs. 24.1%, respectively, p = 0.06), and at six months of age (41.4 vs. 24.1%, respectively, p = 0.16), and significantly lower length of ventilatory support (17.8 vs. 32.3 days, p = 0.01) and NICU stay (34.2 vs. 58.3 days, p = <0.01) compared to controls. Conclusion: FETO was associated with a non‐significant increase in survival and significantly lower neonatal respiratory morbidity among CDH fetuses with moderate lung hypoplasia. Key Points: What's already known about this topic? Fetal endoscopic tracheal occlusion (FETO) has shown an improvement on neonatal survival in fetuses with severe lung hypoplasia.Fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia, that is those with O/E‐LHR between 26% and 35% or between 36% and 45% and liver herniation, are associated with survival rates around 50%. What does this study add? This investigation represents the first study to support the role of FETO in fetuses with left sided CDH and moderate lung hypoplasia. According to our data, a non‐significant increase in survival and a significantly lower neonatal respiratory morbidity were observed in fetuses who underwent FETO compared to those who were managed expectantly and treated with standard postnatal management. [ABSTRACT FROM AUTHOR]

Objective: To evaluate natural history of fetuses congenital diaphragmatic hernia (CDH) prenatally diagnosed in countries where termination of pregnancy is not legally allowed and to predict neonatal survival according to lung area and liver herniation.Methods: Prospective study including antenatally diagnosed CDH cases managed expectantly during pregnancy in six tertiary Latin American centres. The contribution of the observed/expected lung-to-head ratio (O/E-LHR) and liver herniation in predicting neonatal survival was assessed.Results: From the total population of 380 CDH cases, 144 isolated fetuses were selected showing an overall survival rate of 31.9% (46/144). Survivors showed significantly higher O/E-LHR (56.5% vs 34.9%; P < .001), lower proportion of liver herniation (34.8% vs 80.6%, P < .001), and higher gestational age at birth (37.8 vs 36.2 weeks, P < 0.01) than nonsurvivors. Fetuses with an O/E-LHR less than 35% showed a 3.4% of survival; those with an O/E-LHR between 35% and 45% showed 28% of survival with liver up and 50% with liver down; those with an O/E-LHR greater than 45% showed 50% of survival rate with liver up and 76.9% with liver down.Conclusions: Neonatal mortality in CDH is higher in Latin American countries. The category of lung hypoplasia should be classified according to the survival rates in our Latin American CDH registry. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Technological advances are certainly key events in the development of medicine and in particular the field of endoscopic surgery. The use of robotic systems has allowed improving the surgeon's movements during operations. In 1991 appears in the world's first robot assistant for this surgery, the AESOP robot, its function is to hold the laparoscope and move during it. Conceptualize "Self Surgery" as a system of devices for endoscopic surgery assistants with which the surgeon interacts directly with most of the time they are static or limp. Objective: We present the implementation and testing of an original surgical instrument that allows self-management by the surgeon of the camera during the Material and Methods: To make the handling of the optical system used a mechatronic system that consists of a harness, which is placed on the shoulders of the surgeon and has three degrees of freedom, one active and two passive, has a slide-laparosocopio , where the subject and keeps the laparoscope during the procedure. To perform laparoscopic exploration and navigation requires six basic movements: right, left, up, down, enter, leave together describing an inverted cone inside the cavity. Results: The surgeon used his posture and movements visually established in conjunction with the mechatronic assistant work area. The procedure was performed in 60 minutes, there were no complications. The six children were discharged to home 24 hours after the procedure. Discussion: Currently, very few hospitals in our country have the technology for robotic handling of the camera. The mechatronic system shown demonstrated its use in pediatric surgery Nissen "solo surgery", is easily attached before and during surgery. The experience gained and technology developed will establish new methods of navigation are more adaptable to the environment and the maneuverability of the surgeon to perform surgical work better. [ABSTRACT FROM AUTHOR]

Copyright of Boletín Médico del Hospital Infantil de México is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Every year about 5,000 are reported a10, 000 patients with congenital or acquired esophageal requiring surgical treatment, unlike the rest of the gastrointestinal tract is not possible to use autologous tissue for reconstruction because of its limited size and its delicate vascularity, which are used by complex procedures such as colon interposition, a field that has been growing and could provide a solution to these problems is tissue engineering. The purpose of this work involves the construction of a esophageal prosthesis from autologous cells implanted on a collagen matrix and test its usefulness in an animal model. Material and Methods: We took a biopsy of healthy esophageal tissue at the neck of healthy rabbits, which were processed to desegregate its cellular components in epithelial and muscle cell viability was verified by MTT method and their presence by electron microscopy scanning. The prosthesis was implanted in a second surgery to create a defect in "patch" in the native esophagus, further studies of endoscopy, esophagogram and necropsy in animals. Results: After the biopsy epithelial and muscle cells were isolated and multiplied sown and harvested in Petri dishes and seeded at a concentration of 1x! 07 cel/cm2 in intestinal submucosa prostheses. Subsequently, the prostheses were implanted in four healthy rabbits N = 5, all rabbits subsequently underwent esophagogram and endoscopy studies, observing proper integration of the now called neoesófago, with adequate passage of contrast medium showed no leakage or stenosis, all animals remained alive, feeding by mouth without complications so far from being slaughtered except one who died for reasons unconnected with the study. In histopathological studies, there is an almost normal architecture neoesófago presence of mucosa and muscle layer proper. Conclusion: In this study we establish the conditions, general characterization for the isolation and multiplication of epithelial cells and muscle tissue healthy esophageal also created an esophageal prosthesis, which could be implanted in animals to which a defect was created 50 % of the light of it with proper integration of the now called neoesófago. All animals remained alive feeding by mouth without complications, which lays the basis for developing an esophageal prosthesis in the future which can be used in the treatment of children with congenital or acquired esophageal lesions. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to determine the transition in the laparoscopic skills of novice surgeons to the level of advanced surgeons using validated drills in a training box. Materials and methods: A quasi-experimental study of 10 pediatric surgical residents was designed. Residents with previous endoscopic surgical experience equal to or less than five laparoscopic procedures were included. They repeated the MISTELS, Southwestern and Garcia-Ruiz drills until the achievement of a validated performance score for advanced surgeons in 5 consecutive repetitions. Results: The studied group required 12 ± 9 (2-60) repetitions to achieve the specified performance score in the whole set of drills. For the intracorporeal knotting drill they required 11 ± 4 (2-34) repetitions, having a time improvement from 155 to 61 seg (p=0.01); for the extracorporal knotting drill, they required16 ± 7 (4-29) repetitions, with a time improvement from 117 to 46 seg (p=0.002); and for the continuous intracorporeal suture, they required 14 ± 6 (2-23) repetitions and a timing from 559 to 180 seg (p=0.002). Conclusion: After a mean of 12 repetitions, our residents developed skills that Hill probable improve patients security in their first laparoscopic procedures in children. [ABSTRACT FROM AUTHOR]

Background: Pediatric surgical site infection (SSI) rates in the United States range from 2.5% to 4.4%. There is little data regarding their risk factors among children. We quantified SSI rates and identified risk factors of SSI in a tertiary care pediatric teaching hospital in Mexico City., Methods: All neurosurgical, cardiovascular, and general surgical patients who underwent operation between Aug 1, 1998, and Jan 31, 1999, were followed-up daily during hospitalization. On postoperative day 30, a full review of microbiology reports and medical records was performed. Univariate and multivariate analyses were done to identify risk factors., Results: Four hundred twenty-eight of 530 children completed follow-up. The overall SSI rate was 18.7%. Forty percent of SSI were superficial incisional, 21% were deep incisional, and 39% were organ/space infections. For clean, clean-contaminated, contaminated, and dirty procedures, SSI infection rates were 12.4%, 24.4%, 14.3%, and 32.4%, respectively. Open drains (OR = 2.3; 95% CI = 1.3-4.2; P <.005) and surgery that lasted 90 or more minutes (OR = 2.9; 95% CI = 1.6-5.1; P <.001) were associated with infection., Conclusions: Our rates are greater than comparable reported data among children. Duration of surgery and use of open drains were associated with SSI.

Unlabelled: Gastroesophageal reflux (GER) is a common disease in children less one year old. It is present around 10% of unselected infant population. 40-50% have abnormal 24 h pH monitoring. An early diagnosis and treatment should be done in order to avoid complications., Aim: To establish the consensus for the diagnosis and treatment of children with GER, to rule out similar diseases avoid the use of unnecessary drugs and the secondary side effects as well as unnecessary surgery., Method: The consensus was done with the participation of general pediatricians, pediatrics gastroenterologist, pediatric surgeons, radiologist and endoscopist. An initial paper was done by pediatric surgeon and pediatric gastroenterologist who submitted to the rest of participants. Second stage: the paper was review through E-mail for all participants who send their suggestions and modifications. A new paper was done and discussed by medical and surgery area. During the Congress of Pediatric Surgery, in an open session was discuss again with the participation of the main authors and all the audience present. Finally, a paper was done and review for the main authors.