| 1. |
- Anderberg, Magnus, et al.
(författare)
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Morgagni Hernia Repair in a Small Child Using da Vinci Robotic Instruments - A Case Report.
- 2009
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 19, s. 110-112
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The recently introduced use of robotic surgery in minimally invasive surgery procedures facilitates several steps in the operative procedure. We report the first case of a robot-assisted laparoscopic repair of a Morgagni hernia using the da Vinci(R) Surgical System from Intuitive Surgical(R) (Sunnyvale, CA, USA) in a 7.8 kg 18-month-old child. METHODS: Four trocars were used to gain access to the abdomen. The robot-enhanced instruments were used to close the hernia defect with interrupted, absorbable sutures, using intracorporeal knot tying. RESULTS: The operation was completed laparoscopically without a patch. The total setup time for the robotic system was 35 minutes including draping. The operating time at the robotic console was 80 minutes. The child tolerated an oral intake the day after surgery and was discharged home on the third postoperative day. CONCLUSION: Robot-assisted laparoscopic Morgagni hernia repair is feasible in small children.
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| 2. |
- Anderberg, Magnus, et al.
(författare)
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Paediatric robotic surgery in clinical practice: a cost analysis.
- 2009
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 19:5, s. 311-315
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Since 2006 we have used robotic assistance when performing minimally invasive laparoscopic fundoplications in children. We compared the costs of robotic surgery with the costs for open and laparoscopic surgery to test our hypothesis that the increased costs of the new technology are acceptable. METHOD: Costs were calculated using the regional hospital prices for our first 14 fundoplications in children, performed with the aid of the da Vinci Surgical System from Intuitive Surgical. We compared these costs with those of our ten latest fundoplications performed using open and laparoscopic surgery, respectively. There were no differences in the demographic data, work-up or indications for surgery between the three groups of children. RESULTS: The mean cost of robotic surgical fundoplications (EUR 9 584) was 7% higher than the mean cost of laparoscopic surgery (EUR 8 982) and 9% lower than the mean costs for open surgical procedures (EUR 10 521). These differences can be explained by the increased cost of robotic instruments (EUR 2 081 per operation). The duration of the operation and the duration of in-hospital stay are comparable to those of laparoscopic surgical interventions. The time required for the operative intervention was considerably longer than for the open surgical procedure; the duration of the in-hospital stay was only half of that of the open surgical procedure. The patients seemed to benefit from the use of robotic instruments with less morphine (as a marker of less postoperative pain) and a shorter hospital stay. CONCLUSION: The introduction of robotic assistance into surgical practice involves increased in-hospital costs, mainly because of the cost of the new instruments. This increase in cost can be offset by the shorter hospital stay compared to open surgery. After laparoscopic surgery the hospital stay is about the same as after operations performed with robotic assistance. Cheaper instruments and shorter operating time will make robotic surgery cost efficient in the future. The benefit for the patients is less trauma due to the use of minimally invasive surgery and a shorter hospital stay. Thus, the higher initial costs may be considered worthwhile.
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| 3. |
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| 4. |
- Anderberg, Magnus, et al.
(författare)
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Robotic fundoplication in children
- 2007
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Ingår i: Pediatric Surgery International. - : Springer Science and Business Media LLC. - 1437-9813 .- 0179-0358. ; 23:2, s. 123-127
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Tidskriftsartikel (refereegranskat)abstract
- Since January 2006, robotic assistance has been used for performing minimal invasive laparoscopic fundoplications in children. These patients were compared with those operated on with either the open surgical technique or the laparoscopic procedure. The first six children operated on with a fundoplication using the operation robot, da Vinci (R) Surgical System from Intuitive Surgical (R), were included prospectively. As controls, data from the latest six children operated on using the open surgical procedure and the latest six children operated on using the minimal invasive laparoscopic technique were selected retrospectively. All the patients were operated on due to gastroesophageal reflux and were comparable in the De Meester score. The main outcome measures were the operating time, the use of postoperative analgesics, the duration of the postoperative hospital stay and the short-term outcome. There was no significant difference between the three groups concerning age, body weight and preoperative 24 h pH measurement. The mean operating time for the robotic group, 213 min, was the longer one, but the operating time for the latest four patients in the robotic group was similar to that for the laparoscopic group, 189 min. The postoperative hospital stay was shorter and a reduction in the use of analgesics postoperatively was noted. The reduction in the postoperative hospital stay and in the use of analgesics had been already noted with the introduction of the minimal invasive laparoscopic technique. There was no difference in short-term clinical outcome; the gastroesophageal reflux symptoms disappeared in all the patients. Robot-assisted laparoscopic fundoplication is comparable with the standard laparoscopic surgical procedure in terms of duration of operation, postoperative hospital stay, use of postoperative analgesics and short-term clinical outcome. The robotic surgery adds qualities to the surgical work when compared with open or laparoscopic surgery. These include better visualisation for the surgeon and greater precision in the movements of the instruments used.
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| 5. |
- Arnbjörnsson, Einar, et al.
(författare)
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Closure after gastrostomy button
- 2005
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Ingår i: Pediatric Surgery International. - : Springer Science and Business Media LLC. - 1437-9813 .- 0179-0358. ; 21:10, s. 797-799
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Tidskriftsartikel (refereegranskat)abstract
- A gastrostomy device is removed from the gastrostoma when no longer needed. The aim of the study was to test the hypothesis of whether it is possible for the surgeon to decide which stoma has to be closed with a gastroraphy and which to leave for a spontaneous closure within a reasonable period of time. Out of a cohort of 321 patients, who had been operated with a video-assisted gastrostomy, we included all the 48 patients having had their gastrostomy button removed. These patients were carefully followed and the closure of the gastrostoma was registered. According to the institutional routine we waited at least 3 months after the removal of the gastrostomy device before suggesting to the child's guardians an operative closure of the stoma. In 26 patients the stoma closed within 3 months, whereas in 22 patients a surgical gastroraphy was performed. We found no differences between the two groups regarding the patients' diagnoses, the duration of the gastrostoma use or patient's age at the time of removal of the gastrostomy device. This study rejected the hypothesis of predictability of the gastrostoma closure. Thus, we recommend a routine expectance after the removal of a gastrostomy device for at least 1 month. If no spontaneous closure occurs, then a gastroraphy should be performed.
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| 6. |
- Arnbjörnsson, Einar, et al.
(författare)
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Correlation between the preoperative state of nutrition and the frequency of postoperative problems after video-assisted gastrostomy in children.
- 2009
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Ingår i: Gastroenterology Insights. - : MDPI AG. - 2036-7422 .- 2036-7414. ; volume 1:e2:2
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Gastrostomy operations are performed on children referred to the pediatric surgical clinic without being influenced by the patient’s state of nutrition. This has been motivated by the idea that a gastrostomy would enable a fast and secure improvement in this regard. The question arises whether an improvement in the preoperative nutritional status would reduce the number of postoperative complications. The aim of the study was to test the hypothesis that the frequency of postoperative complications after a video-assisted gastrostomy is correlated to the child’s preoperative state of nutrition. Fifty consecutive children with severe nutritional problems underwent a video-assisted gastrostomy operation where gastrostomy buttons were placed as the initial surgical feeding tube. At the time of the operation, the children’s nutritional parameters were registered routinely. After the operation, the children were followed up prospectively for six months and all complications were documented according to a protocol. The children were ranked according to the severity and frequency of postoperative complications and problems. Correlation to nutritional parameters was calculated. The children did not present with any serious postoperative intraabdominal complications. There was a significant correlation between the frequency of minor complications and the child’s state of nutrition, measured as the number of standard deviations from normal length and weight as well as phosphate, magnesium, and iron levels in the blood. This study revealed a significant correlation between the patients’ state of nutrition and the postoperative complications during the first postoperative six months. Thus, the findings support a routine of nutritional evaluation prior to performing a gastrostomy operation.
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| 7. |
- Arnbjörnsson, Einar, et al.
(författare)
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Video vägleder vid anläggning av gastrostomiknapp hos barn. Tio års erfarenheter visar metodens fördelar
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:46, s. 5-3451
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Tidskriftsartikel (refereegranskat)abstract
- Tio års erfarenheter av att anlägga gastrostomier på barn med hjälp av videoendoskop redovisas. I patientgruppen ingår 300 barn i åldern 3 månader till 18 år med neurologiska åkommor, metabola sjukdomar, medfödda hjärtmissbildningar och maligna sjukdomar. Operationen görs i intubationsnarkos med en videoassisterad anläggning av gastrostomi där en s k gastrostomiknapp placeras direkt i stomat och används så fort barnet har vaknat. Några svåra operativa eller postoperativa komplikationer, såsom blödningar, fistlar till kolon eller behov av akut reoperation, har inte förekommit. Lokala problem runt själva stomat är vanliga, liksom vid andra gastrostomimetoder. Vi rekommenderar den här beskrivna videoassisterade tekniken för användning på barn om de anatomiska förutsättningarna så tillåter.
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| 8. |
- Backman, Torbjörn, et al.
(författare)
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Complications of video-assisted gastrostomy in children with or without a ventriculoperitoneal shunt
- 2007
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Ingår i: Pediatric Surgery International. - : Springer Science and Business Media LLC. - 1437-9813 .- 0179-0358. ; 23:7, s. 665-668
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to test the hypothesis that the presence of a ventriculoperitoneal shunt ( VPS) influences the frequency of postoperative complications after video-assisted gastrostomy ( VAG) in children. When using a power of 80%, a critical value for significance of 5% and an assumed population-based standard deviation of 0.4, it will be required to have a sample size of at least 14 children to show that a difference of 0.6 is significant when using Student's t test for paired samples. Thus, 15 consecutive children with VPSs were included in the present study. All the children had nutritional problems and underwent a VAG operation at a tertiary care university hospital. After the operation, the children were prospectively followed up. Specially trained nurses documented all complications according to a protocol. For the purpose of comparison, we had a control group of neurologically disabled children without VPSs, matched for age and operated with VAG. The children did not present with any serious postoperative intra-abdominal complications or central nervous system infection. There was no significant difference in the frequency of minor complications between the studied group and the control group. This study did not reveal that children with VPSs who undergo a VAG button placement are at high risk for infection and subsequent shunt malfunction. They did not have more postoperative problems than a matched control group of neurologically disabled children.
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| 9. |
- Backman, Torbjörn, et al.
(författare)
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Omentum Herniation at a 2-mm Trocar Site.
- 2005
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Ingår i: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. - : Mary Ann Liebert Inc. - 1557-9034 .- 1092-6429. ; 15:1, s. 87-88
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Tidskriftsartikel (refereegranskat)
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| 10. |
- Bard, Delphine, et al.
(författare)
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Newborn pain cry analysis based on pitch frequency tracking.
- 2008
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Ingår i: The Journal of the Acoustical Society of America. - : Acoustical Society of America (ASA). - 1520-8524 .- 0001-4966. ; 123:5
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the newborn pain cry analysis is to test the hypothesis that cry can be used as a tool to detect signs of nocioceptive pain. Previous studies applying signal processing techniques to analyze the sound of these cries have been done. The subject of this paper is to adapt and improve the original method with the help of new signal processing methods. The pitch frequency is extracted from the waveform of the recorded babies' cries using time domain methods. The fluctuations of this parameter are analyzed in terms of jitter. In particular, a sliding buffer approach is presented, as well as an improvement of the Average Mean Difference Function (AMDF). Comparison between original and news results has been done.
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