Jones Vinci S, Cohen Ralph C
Department of Pediatric Surgery, The Children's Hospital at Westmead, Sydney 2145, NSW, Australia.
J Pediatr Surg. 2008 Sep;43(9):1653-9. doi: 10.1016/j.jpedsurg.2008.01.006.
The past 2 decades have seen a rapid integration of minimally invasive surgery (MIS) to pediatric surgical practice. This study endeavored to delineate the current status of MIS in pediatric surgery.
Three hundred six pediatric surgeons were invited to participate in an anonymous Web-based survey. Apart from demographic details and opinion regarding robotic surgery, surgeons were asked to choose between "perform MIS," "do not perform MIS but recommend it," and "MIS not indicated" for common pediatric surgical conditions.
Responses were received from 117 pediatric surgeons (38.2%). Sixty-one percent of respondents did more than 10% of their work using MIS, and 85% had more than 5 years experience in MIS. Cholecystectomy, nonpalpable testis, and exploration for abdominal pain scored highest among the positive recommendations for MIS, whereas liver tumors, biliary atresia, Wilms' tumor, and inguinal hernia scored highest among the negative recommendations for MIS. Fifty-one percent of the respondents had more than 20 years experience as a pediatric surgeon and were categorized as "senior" surgeons. Compared with the young surgeons, the senior surgeons were more likely to recommend MIS as a contraindication for simple and complicated appendicitis, reduction of intussusception, gastrostomy, fundoplication, pyloromyotomy, adhesiolysis, splenectomy, adrenalectomy, nephrectomy for dysplastic kidneys, heminephrectomy, pyeloplasty, anorectal malformations, pyeloplasty, achalasia cardia, hiatal hernia repair, lung resection, and diaphragmatic hernia repair. More than half the respondents believed that robotic surgery has a role for children in the future.
A widespread integration of MIS into the pediatric surgical practice is evident from this study. Current practice and recommendations of the surveyed surgeons have been outlined. Significant differences between the young and senior surgeons reflect the evolving nature of the recommendations.
在过去20年里，微创手术（MIS）迅速融入小儿外科实践。本研究旨在描绘小儿外科中MIS的现状。
邀请306名小儿外科医生参与一项基于网络的匿名调查。除了人口统计学细节和关于机器人手术的意见外，还要求外科医生针对常见小儿外科疾病在“进行MIS”、“不进行MIS但推荐它”和“不适合MIS”之间做出选择。
收到了117名小儿外科医生（38.2%）的回复。61%的受访者使用MIS完成了超过10%的工作，85%的人有超过5年的MIS经验。在MIS的积极推荐中，胆囊切除术、不可触及睾丸和腹痛探查得分最高，而在MIS的消极推荐中，肝肿瘤、胆道闭锁、肾母细胞瘤和腹股沟疝得分最高。51%的受访者有超过20年的小儿外科医生经验，被归类为“资深”外科医生。与年轻外科医生相比，资深外科医生更有可能将MIS推荐为单纯性和复杂性阑尾炎、肠套叠复位、胃造口术、胃底折叠术、幽门肌切开术、粘连松解术、脾切除术、肾上腺切除术、发育不良肾脏的肾切除术、半肾切除术、肾盂成形术、肛门直肠畸形、肾盂成形术、贲门失弛缓症、食管裂孔疝修补术、肺切除术和膈疝修补术的禁忌证。超过一半的受访者认为机器人手术在未来对儿童有作用。
本研究表明MIS已广泛融入小儿外科实践。概述了受访外科医生的当前实践和建议。年轻和资深外科医生之间的显著差异反映了建议的不断演变性质。
