Virtual Fixture Assistance for Suturing in Robot-Aided Pediatric Endoscopic Surgery

The limited workspace in pediatric endoscopic surgery makes surgical suturing one of the most difficult tasks. During suturing, surgeons have to prevent collisions between tools and also collisions with the surrounding tissues. Surgical robots have been shown to be effective in adult laparoscopy, but assistance for suturing in constrained workspaces has not been yet fully explored. In this letter, we propose guidance virtual fixtures to enhance the performance and the safety of suturing while generating the required task constraints using constrained optimization and Cartesian force feedback. We propose two guidance methods: looping virtual fixtures and a trajectory guidance cylinder, that are based on dynamic geometric elements. In simulations and experiments with a physical robot, we show that the proposed methods achieve a more precise and safer looping in robot-assisted pediatric endoscopy.Comment: Accepted on RA-L/ICRA 2020, 8 Pages. Fixed a few typo

Stapled intestinal anastomosis is a simple and reliable method for management of intestinal caliber discrepancy in children

PURPOSE: Popularity of minimally invasive surgeries has led to the development of stapled intestinal anastomosis for adults. The advanced instruments used in this technique are getting suitable with the small intestinal lumens of neonates and infants. We reviewed and compared the intraoperative and postoperative results of stapled and hand-sewn anastomoses in children. METHODS: The operative data of children who underwent stapled and hand-sewn anastomoses between March 2005 and December 2011 were collected and analyzed retrospectively. Furthermore, we compared patients who underwent anastomoses for colostomy closure of anorectal malformation (4 stapled, 9 hand-sewn) and those who underwent anastomoses for treatment of ileal atresia (3 stapled, 11 hand-sewn). RESULTS: In the 47 patients who underwent stapled anastomosis, no intraoperative complications were observed and postoperative complications included wound infection (n = 3), delayed gastric emptying (n = 1), and ileus (n = 1). No complications suggesting anastomotic dilatation were identified. It was observed that patients who underwent stapled anastomosis for colostomy takedown with caliber discrepancy had significantly shorter surgery time than those who underwent hand-sewn anastomosis. CONCLUSION: Our results suggest that stapled anastomosis is safe and effective for various surgical diseases in neonates, infants, and children

Point-of-Care Ultrasound for Mimicker Lesions of Incarcerated Inguinal Hernia

Inguinal hernia is the most common surgical disease in pediatric patients, and urgent intervention such as manual reduction is needed for incarcerated inguinal hernia. Torsion of undescended testes, inguinal herniated ovarian torsion, and purulent lymphadenitis are mimickers of this condition. If these mimicker lesions are misdiagnosed as incarcerated inguinal hernia, manual reduction usually fails, and edematous and erythematous changes may occur in these mimicker lesions due to manual reduction. For physicians in the emergency department, prompt decisions and familiarity with the sonographic appearance of different contents within an inguinal hernia are important to accurately diagnose these mimickers. In this case series, we present sonographic images of a typical case of incarcerated inguinal hernia (an 11-month-old male with right incarcerated inguinal hernia) and three cases of mimicker lesions (a 7-month-old female with herniated ovarian torsion, a 7-year-old boy with undescended testicular torsion, and a 2-month-old male with purulent lymphadenitis). The incidence of incarcerated inguinal hernia is reported to be higher in males (80%), on the right side (60%), and in infants and toddlers. This information is important for diagnosing mimicker lesions. In addition, to prevent manual reduction in mimicker diseases, point-of-care ultrasound before manual reduction in suspected cases of incarcerated inguinal hernia is important

SmartArm: Suturing Feasibility of a Surgical Robotic System on a Neonatal Chest Model

Commercially available surgical-robot technology currently addresses many surgical scenarios for adult patients. This same technology cannot be used to the benefit of neonate patients given the considerably smaller workspace. Medically relevant procedures regarding neonate patients include minimally invasive surgery to repair congenital esophagus disorders, which entail the suturing of the fragile esophagus within the narrow neonate cavity. In this work, we explore the use of the SmartArm robotic system in a feasibility study using a neonate chest and esophagus model. We show that a medically inexperienced operator can perform two-throw knots inside the neonate chest model using the robotic system.Comment: Accepted on T-MRB 2021, 4 page

Operative procedures of single-incision laparoscopic repair of pediatric epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle

We describe a simple and feasible procedure for single-incision laparoscopic repair of a pediatric epigastric hernia using a novel suture-assisting needle. A multichannel port was inserted through the umbilical vertical incision. After the orifice of the hernia was identified, a suture-assisting needle, which can hold a suture at its tip, with a 2-0 thread was pierced through the skin into one side of the rectus muscle sheath into the abdominal cavity. Next, after releasing the thread, the needle was pulled out to the subcutis and pierced through another side of the rectus muscle sheath. The needle, grasping the thread again, was subsequently pulled out through the abdominal wall outside, and the thread was tied extracorporeally. This knot was buried subcutaneously. Operative procedures of single-incision laparoscopic repair of an epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle with an excellent cosmetic result

Towards robust needle segmentation and tracking in pediatric endoscopic surgery

Neonatal tracheoesophageal fistula surgery poses technical challenges to surgeons, given the limited workspace and fragile tissues. In previous studies from our collaborators, a neonatal chest model was developed to allow surgeons to enhance their performance, such as suturing ability, before conducting actual surgery. Endoscopic images are recorded while the model is used, and surgeon skill can be manually assessed by using a 29-point checklist. However, that is a time-consuming process. In the checklist, there are 15 points that regard needle position and angle that could be automatized if the needle could be efficiently tracked. This paper is a first step towards the goal of tracking the needle. Pixel HSV color space channels, opponent color space channels, and pixel oriented gradient information are used as features to train a random forest model. Three methods are compared in the segmentation stage: single pixel features, pixel and its immediate 10-by-10 square window features, and the features of randomly offset pixels in a larger 169-by-169 window. Our analysis using 9-fold cross-validation shows that using randomly offset pixels increases needle segmentation f-measure by 385 times when comparing with single pixel color, and by 3 times when comparing with the immediate square window even though the same amount of memory is used. The output in the segmentation step is fed into a particle filter to track the full state of the needle.</p

Laparoscopic side-to-side pancreaticojejunostomy for chronic pancreatitis in children

Surgical pancreatic duct (PD) drainage for chronic pancreatitis in children is relatively rare. It is indicated in cases of recurrent pancreatitis and PD dilatation that have not responded to medical therapy and therapeutic endoscopy. We performed laparoscopic side-to-side pancreaticojejunostomy for two paediatric patients with chronic pancreatitis. The main PD was opened easily by electrocautery after locating the dilated PD by intraoperative ultrasonography. The dilated PD was split longitudinally from the pancreatic tail to the pancreatic head by laparoscopic coagulation shears or electrocautery after pancreatography. A laparoscopic side-to-side pancreaticojejunostomy was performed by a one-layered technique using continuous 4-0 polydioxanone (PDS) sutures from the pancreatic tail to the pancreatic head. There were no intraoperative or postoperative complications or recurrences. This procedure has cosmetic advantages compared with open surgery for chronic pancreatitis. Laparoscopic side-to-side pancreaticojejunostomy in children is feasible and effective for the treatment of chronic pancreatitis

A new laparoscopic triangle fixation technique for gastrostomy : a safe and effective procedure for reduction of the wound infection rate

Gastrostomy is often performed with fundoplication in handicapped children. We devised a new laparoscopic triangle fixation technique for gastrostomy. In this study, 100 patients underwent gastrostomy with fundoplication between January 2008 and January 2016. We retrospectively reviewed the early postoperative results between the new laparoscopic procedure (NLP) group (n = 63) and conventional procedure (CP) group (n = 37). In the CP, the gastrostomy tube was inserted with a purse-string ligature at the gastric wall, and the gastric wall was sutured to the peritoneum under a small laparotomy. In NLP, three sutures were placed on the gastric wall, forming the three sides of a triangle, and the tube was inserted into the center of the triangle. The ends of each suture were pulled directly through the abdominal wall using a laparoscopic percutaneous extraperitoneal closure needle to join the gastric wall and peritoneum. Both groups showed no significant differences in age, body weight, and external leakage rate. The wound infection rate was significantly lower in the NLP group. In conclusions, the NLP is straightforward and can achieve firm fixation between the stomach and abdominal wall by suturing in the form of a triangle. The NLP was associated with a lower complication rate, especially concerning infection