Laparoscopy in Children

VIII, 148 p. 172 illus., 171 illus. in color.onli

Acute appendicitis: A continuing challenge for both clinicians and pathologists

No Abstract

Towards AI-driven minimally invasive needle interventions

The overall complication rate during laparoscopic access is estimated to be as high as 14 %. Surgeons have to rely heavily on their experience and haptic perception while inserting the Veress needle or a trocar into the peritoneal cavity. Surgical Audio Guidance (SURAG) is a promising alternative to current techniques. It acquires instrument-born vibroacoustic (VA) waves to track the insertion of the instrument and provide real-time feedback to surgeons. This article presents an initial evaluation of the SURAG technology through two sets of experiments to classify Veress needle events using different AI-models. The results demonstrate the feasibility of using AI for classifying Veress needle events and the potential of the SURAG technology to support surgeons during laparoscopic access and minimally invasive needle interventions in general

Gaucher's disease in children: Case report from Afghanistan with literature review

Introduction and importance: Gaucher's disease (GD) or lysosomal storage disease, is one of the rare genetic disorders resulting from glucocerebrosidase deficiency. Clinical manifestations include a swollen belly (hepatosplenomegaly), bruising due to thrombocytopenia, anemia, fatigue, bone pain, and neurological involvement. Diagnosis is made by measuring the level of glucocerebrosidase enzyme in the blood, using dual energy X-ray absorptiometry (DXA), and performing genetic tests. For some types of GD, enzyme therapy is now available. Case presentation: A 5-year-old child with a high-grade fever and splenomegaly was admitted to our teaching hospital's pediatric surgery department. The patient had genetic screening in early childhood outside the country, confirming the diagnosis of GD. Following the appropriate anti-bacterial therapy, the patient underwent splenectomy for conditions such as splenomegaly, lack of enzyme replacement therapy, and the patient's susceptibility to trauma. Clinical discussion: GD is a rare disease that is frequently confused with thalassemia. If there are no visible signs and symptoms, the disease is overlooked and left untreated. Our clinical justifications for surgical operation (splenectomy) were splenomegaly, lack of enzyme replacement therapy (an integral part of gaucher's disease treatment), and prevention of splenic rupture (as a result of falling down due to child neglect, which is common in Afghanistan). During the 1-year post-operative follow-up, our patient experienced two episodes of high-grade fever, which were treated appropriately. Conclusion: Due to the rarity of GD, the disease is left untreated and undiagnosed for a long time, mainly in developing countries where definite diagnostic modalities are not readily available. Diseases with similar symptoms should always be considered in the differential diagnosis. Early enzyme replacement therapy is the key to improve the quality of life, but it is not available in developing nations

Pectus excavatum: History, hypotheses and treatment options

Abstract Pectus excavatum and pectus carinatum represent the most frequent chest wall deformations. However, the pathogenesis is still poorly understood and research results remain inconsistent. To focus on the recent state of knowledge, we summarize and critically discuss the pathological concepts based on the history of these entities, beginning with the first description in the sixteenth century. Based on the early clinical descriptions, we review and discuss the different pathogenetic hypotheses. To open new perspectives for the potential pathomechanisms, the embryonic and foetal development of the ribs and the sternum is highlighted following the understanding that the origin of these deformities is given by the disruption in the maturation of the parasternal region. In the second, different therapeutical techniques are highlighted and based on the pathogenetic hypotheses and the embryological knowledge potential new biomaterial-based perspectives with interesting insights for tissue engineering-based treatment options are presented