{"id":260,"date":"2018-10-08T07:01:32","date_gmt":"2018-10-08T07:01:32","guid":{"rendered":"http:\/\/www.drmuratalkan.com\/?page_id=260"},"modified":"2018-11-27T09:52:05","modified_gmt":"2018-11-27T09:52:05","slug":"laparoskopik-girisimler","status":"publish","type":"page","link":"https:\/\/www.drmuratalkan.com\/en\/laparoskopik-girisimler\/","title":{"rendered":"Laparoscopic Interventions"},"content":{"rendered":"
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LAPAROSCOPY-THORACOSCOPY IN NEWBORN<\/strong><\/p>\n

With the development of technology and industry, laparoscopic or thoracoscopic procedures that can be performed in adults and children can now be performed in the neonatal period thanks to the increase in the experience of the surgeon and anesthesiologist and the miniaturization of endoscopic instruments.<\/p>\n

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Uses of Laparoscopy in the Newborn<\/strong><\/p>\n

\u00a0<\/em><\/strong><\/p>\n

Laparoscopy Assisted Cholangiography<\/em><\/strong><\/p>\n

If biliary atresia is suspected in a newborn with prolonged jaundice, cholangiography is the gold standard for diagnosis. After laparoscopy is performed to determine the presence of the gallbladder, percutaneous and transhepatic cholangiography can be performed with a needle inserted into the gallbladder to demonstrate patency or absence of the biliary tract and avoid unnecessary laparotomies. (1)<\/sup> .<\/p>\n

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Laparoscopic Pyloromyotomy<\/em><\/strong><\/p>\n

Pyloromyotomy is a highly experienced procedure in laparoscopy and has a high learning curve(2)<\/sup>. In a meta-analysis by Oomen et al. evaluating the complication rates in open and laparoscopic pyloromyotomies, a total of 502 cases were reviewed in 4 separate studies. The complication rate was 11% in open pyloromyotomy and 10.5% in laparoscopic pyloromyotomy. There was no statistical difference in complications after both methods. (3)<\/sup>. Considering the advantages of minimally invasive surgery, laparoscopic pyloromyotomy may be preferable in experienced hands.<\/p>\n

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Ovarian cysts - Laparoscopy<\/em><\/strong><\/p>\n

Ovarian cysts can be seen in the fetal and neonatal period. Depending on the size of the cyst, it is decided whether or not to intervene. Cysts larger than 4 cm in size require surgical intervention as they may lead to ovarian torsion, hemorrhage or intestinal obstruction(4)<\/sup>. Laparoscopic intervention is preferred because of the combination of diagnosis and treatment, short duration, short post-op care, less pain, and less incision scar. If ovarian tissue filled with debris, calcified or hyperechogenic structures is detected on postpartum ultrasonography, a torsiated, necrotic ovary may be considered. If there is no necrosis, ovarian detorsion and cyst aspiration or resection can be performed. (5)<\/sup>. Ovarian fixation with laparoscopic detorsion can be performed according to the surgeon's preference.<\/p>\n

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Anorectal malformations-Laparoscopy<\/em><\/strong><\/p>\n

Laparoscopy-assisted anorectal malformation correction surgery was first described by Georgeson in 2000(6)<\/sup>. Pena initiated the discussion on the need to select cases for laparoscopy-assisted correction(7)<\/sup>. In the neonatal period, colostomy and then definitive surgery is the generally accepted treatment for high-type atresia.<\/p>\n

Uses of Thoracoscopy in the Newborn<\/em><\/strong><\/p>\n

Thoracoscopy is preferred because of less postoperative pain, cosmetically satisfactory, short hospital stay, absence of abnormal rib union after thoracotomy and therefore absence of future shoulder drop and less scoliosis. Indications for thoracoscopy in the neonatal period are quite rare. The most popular indication is esophageal atresia repair.<\/p>\n

Thoracoscopic Esophageal Atresia and Tracheoesophageal Fistula Repair<\/em><\/strong><\/p>\n

Thoracoscopic esophageal atresia repair was first performed in 1999 and is now an accepted minimally invasive approach(8)<\/sup>. A 2012 meta-analysis compared thoracoscopic and thoracotomy repairs and found that the incidence of postoperative complications, anastomotic leaks or stenoses was not statistically different (9)<\/sup> . Various methods have been described for long intermittent esophageal atresia. Although the thoracoscopic approach does not cause cosmetic and postural scoliosis, the rate of scoliosis in newborns undergoing thoracotomy is 30%. (10,11)<\/sup> .<\/p>\n

\u00a0<\/em><\/strong><\/p>\n

Congenital Pulmonary Malformation<\/em><\/strong><\/p>\n

Cystic diseases of the lung diagnosed by prenatal ultrasound (congenital pulmonary malformation, lobar emphysema, sequestration) usually have indications for surgery when symptomatic. They are very rarely symptomatic in the neonatal period. Some studies suggest that it is easier to operate thoracoscopically without being symptomatic, i.e. without recurrent infections (12,13)<\/sup> . In the meta-analysis, no difference was found between the operative times and postoperative complications in congenital lung lesions, whether performed thoracoscopically or by thoracotomy. (14)<\/sup> .<\/p>\n

\u00a0<\/em><\/strong><\/p>\n

Conjugate diaphragmatic hernia<\/em><\/strong><\/p>\n

Congenital diaphragmatic hernia repair can be performed both laparoscopically and thoracoscopically. The thoracoscopic approach provides an advantage in surgical technique due to the fact that the intestines filling the thorax move into the abdomen, while a possible malrotation may be missed. In Landsdale's meta-analysis, open surgery was found to be more advantageous because of the longer duration of the thoracoscopic approach and the higher recurrence rate.(15)<\/sup>. In addition, neurotoxic side effects due to carbon dioxide absorption, prolonged hypercapnia and acidosis in thoracoscopic intervention make open surgery preferable. (16)<\/sup> . The most common conversion rate to open surgery in neonatal minimally invasive procedures (including infants under 5 kg) is 15% and is seen in diaphragmatic hernia repair (17)<\/sup> .<\/p>\n

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Result<\/strong><\/p>\n

Minimally invasive methods are known to have advantages over open surgery such as being more cosmetic, shorter hospital stay and less need for postoperative analgesics. Almost all surgeries in adults can be performed with an endoscopic approach. With the development of technology and the experience of surgeons and anesthesiologists, many surgeries performed with open surgical technique can be performed safely and successfully with minimally invasive methods, regardless of age and weight, whether newborn or infant under 5 kg.<\/p>\n

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References:<\/strong><\/p>\n

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  1. Alkan M, Tutus K, Fak\u0131o\u011flu E, et al. Laparoscopy-assisted percutaneous cholangiography in biliary atresia diagnosis: Comparison with open technique. Gastroenterology Research and Practice Volume 2016. DOI\/10.1155\/2016\/5637072<\/li>\n
  2. Oomen MW, Hoekstra LT, Bakx R, et al. Learning curves for pediatric laparoscopy: how many operations are enough? The Amsterdam experience with laparoscopic pyloromyotomy. Surg Endosc. 2010 ;24:1829-1833<\/li>\n
  3. Oomen MW, Hoekstra LT, Bakx R, et al. Open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a systematic review and meta-analysis focusing on major complications. Surg Endosc 2012, 26; 8:2104-2110<\/li>\n
  4. Huchon C, Fauconnier A. Adnexal torsion: a literat\u00fcre review. Eur J Obstet Gynecol Reprod Biol 2010;150:8-12<\/li>\n
  5. Alkan M, Elbek A, Evruke C, et al. Laparoscopic management of synchronous bilateral ovarian torsion in a neonate. J Neonat Surg. 2016; 5:7<\/li>\n
  6. Georgeson KE, Inge TH, Albanase CT. Laparoscopically assisted anorectal pull-through for high imperforate an\u00fcs-a new technique. J Pediatr Surg. 2000;35;927-930.<\/li>\n
  7. Bischoff , Levitt MA, Pena A. Laparoscopy and its use in the repair of anorectal malformations. J Pediatr Surg. 2011;46: 1609-1617<\/li>\n
  8. Rothenberg SS. Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates: evolution of a technique. J Laparoendosc Adv Surg Tech A, 2012;22: 195-199<\/li>\n
  9. Borruto FA, Impellizzeri P, Montalto AS, et al. Thoracoscopy versus thoracotomy for esophageal atresia and tracheoesophageal fistula repair: review of the literature and meta-analysis. Eur J Pediatr Surg. 2012 ;22:415-419.<\/li>\n
  10. Van Biezen FC, Bakx PA, DeVilleneuve VH, et al. Scoliosis in children after thoracotomy for aortic coarctation. J Bone Joint Surg Am. 1993;75(4):514-8.<\/li>\n
  11. Westfelt JN, Nordwall A. Thoracotomy and scoliosis. Spine 1991;16:1124-5<\/li>\n
  12. Boubnova J, Peycelon M, Garbi O, et al. Thoracoscopy in the management of congenital lung diseases in infancy. Surg Endosc. 2011;25:593-596<\/li>\n
  13. Rothenberg SS. First decade\u2019s experience with thoracoscopic lobectomy in infants and children. J Pediatr Surg 2008;43: 40-44<\/li>\n
  14. Nasr A, Bass J. Thoracoscopic vs open resection of congenital lung lesions: a meta-analysis. J Pediatr surg 2012;47:857-861<\/li>\n
  15. Lansdale\u00a0 N, Alam S, Losty PD, et al. Neonatalendosurgical congenital diaphragmatic hernia repair: a systematic review and meta-analysis. Ann Surg. 2010;252:20-26<\/li>\n
  16. Bishay M, Giacomello L, Retrosi G, et al. Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia: results of a pilot randomized controlled trial. Ann Surg. 2013;258: 895-900<\/li>\n
  17. Sinha CK, Paramalingam S, Patel S, et al. Feasibility of complex minimally invasive surgery in neonates. Pediatr Surg Int 2009;25: 217-221<\/li>\n<\/ol>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div>

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    <\/div>","protected":false},"excerpt":{"rendered":"YEN\u0130DO\u011eAN\u2019DA LAPAROSKOP\u0130- TORAKOSKOP\u0130 Teknolojinin ve end\u00fcstrinin geli\u015fmesiyle birlikte, cerrah\u0131n ve anestezistin tecr\u00fcbesinin artmas\u0131 ve endoskopik enstr\u00fcmanlar\u0131n minyat\u00fcrize \u00fcretilmesi sayesinde eri\u015fkin ve \u00e7ocuklarda yap\u0131labilen laparoskopik veya torakoskopik uygulamalar g\u00fcn\u00fcm\u00fczde yenido\u011fan d\u00f6neminde de yap\u0131labilmektedir. \u00a0 Yenido\u011fanda Laparoskopinin Kullan\u0131m Alanlar\u0131 \u00a0 Laparoskopi Yard\u0131ml\u0131 Kolanjiografi Uzam\u0131\u015f sar\u0131l\u0131kl\u0131 yenido\u011fanda biliyer atrezi \u015f\u00fcphesi varsa kolanjiografi tetkiki tan\u0131da alt\u0131n standartt\u0131r. Laparoskopi yap\u0131larak [...]","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-260","page","type-page","status-publish","hentry"],"yoast_head":"\nLaparoskopik Giri\u015fimler - \u00c7ocuk Cerrahisi ve \u00c7ocuk \u00dcrolojisi, Hipospadias, S\u00fcnnet - Prof.Dr. Murat Alkan<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.drmuratalkan.com\/en\/laparoskopik-girisimler\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Laparoskopik Giri\u015fimler - \u00c7ocuk Cerrahisi ve \u00c7ocuk \u00dcrolojisi, Hipospadias, S\u00fcnnet - Prof.Dr. Murat Alkan\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.drmuratalkan.com\/en\/laparoskopik-girisimler\/\" \/>\n<meta property=\"og:site_name\" content=\"\u00c7ocuk Cerrahisi ve \u00c7ocuk \u00dcrolojisi, Hipospadias, S\u00fcnnet - 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