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Esophageal atresia (EA) is a rare birth defect in which respiratory tract disorders are a major cause of morbidity. It remains unclear whether respiratory tract disorders are in part caused by alterations in airway epithelial cell functions such as the activity of motile cilia. This can be studied using airway epithelial cell culture models of patients with EA. Therefore, the aim of this study was to evaluate the feasibility to culture and functionally characterize motile cilia function in the differentiated air–liquid interface cultured airway epithelial cells and 3D organoids derived from nasal brushings and bronchoalveolar lavage (BAL) fluid from children with EA. We demonstrate the feasibility of culturing differentiated airway epithelia and organoids of nasal brushings and BAL fluid of children with EA, which display normal motile cilia function. EA patient-derived airway epithelial cultures can be further used to examine whether alterations in epithelial functions contribute to respiratory disorders in EA.

Background Thoracoscopic external traction technique (TTT) is a relatively new surgical intervention for patients with long-gap esophageal atresia (LGEA) that preserves the native esophagus. The major accomplishment with TTT is that esophageal repair can be achieved within days after birth. This study evaluates the childhood outcome in LGEA patients treated with TTT, including gastrointestinal outcome, nutritional status and Health-Related Quality of Life (HRQoL). Methods A cohort study including all LGEA patients that underwent TTT between 2006-2017 was conducted. Patients and/or their parents were invited to fill out questionnaires regarding reflux symptoms and HRQoL. Results TTT was successful in 11/13 patients (85%). Esophageal anastomosis was accomplished at a median age of 12 days (range 7-138), first oral feeding was started at a median of 16 days postoperatively (range 5-37). All patients required multiple dilatations and 10 patients required anti-reflux surgery. At median follow-up of seven years, five patients reported mild and one moderate reflux complaints. All patients but one reached age-appropriate oral diet. Most patients (80%) were within normal growth range. Overall HRQoL was comparable to healthy controls. Conclusion TTT provides acceptable results in childhood. Oral feeding can be started as soon as two weeks postoperatively. Almost all patients are able to eat an age-appropriate oral diet. Overall HRQoL was comparable to healthy controls.

Background: Esophageal atresia (EA) is a rare congenital malformation of the esophagus. Surgical treatment is required to restore the continuity of the esophagus. This can be performed through thoracotomy. However, an increasing number of hospitals is performing minimal invasive surgery (MIS). In this article, we describe the technique of thoracoscopic repair of EA in neonates in more detail and show the outcome of a patient cohort operated by young pediatric surgeons in training. Methods: Between 2014 and 2019 correction was performed in 64 EA type C patients at the UMC Utrecht, Wilhelmina Children's Hospital, mainly by young pediatric surgeons in training. Results: All patients were corrected through MIS, 3 days after birth. The median operation duration was 181 (127-334) minutes. Nasogastric tube feeding was started on the first postoperative day, and oral feeding 6 days postop. Postoperative complications included leakage (14.1%), stenosis (51.1%), and recurrent tracheoesophageal fistula (7.8%). Conclusion: Thoracoscopic repair of EA can be performed safely, with good outcome and all the benefits of MIS. However, it remains a challenging procedure and should be performed only in pediatric centers with a vast experience in MIS, especially when training young pediatric surgeons. These centers must have access to a multidisciplinary team of neonatologists, pediatric anesthesiologists, surgeons, and ENT specialists to ensure the best possible care in hemodynamic, respiratory, and cerebral monitoring and gastrointestinal and developmental outcome.

Item does not contain fulltext No data exists concerning the application of a new robotic system with 3-mm instruments (Senhance™, Transenterix, Milano, Italy) in small cavities. Therefore, the aim of this study was to test the system for its performance of intracorporal suturing in small boxes simulating small body cavities. Translucent plastic boxes of decreasing volumes (2519-90 ml) were used. The procedures (two single stitches, each with two consecutive surgical square knots) were performed by a system-experienced and three system-inexperienced surgeons in each box, starting within the largest box, consecutively exchanging the boxes into smaller ones. With this approach, the total amount of procedures performed by each surgeon increased with decreasing volume of boxes being operated in. Outcomes included port placement, time, task completion, internal and external instrument/instrument collisions and instrument/box collisions. The procedures could be performed in all boxes. The operating time decreased gradually in the first three boxes (2519-853 ml), demonstrating a learning curve. The increase of operating time from boxes of 599 ml and lower may be attributed to the increased complexity of the procedure in small cavities as in the smallest box with the dimensions of 2.9 × 6.3 × 4.9 cm. This is also reflected by the parallel increase of internal instrument-instrument collisions. With the introduction of 3-mm instruments in a new robotic surgical system, we were able to perform intracorporal suturing and knot tying in cavities as small as 90 ml. Whether this system is comparable to conventional three-port 3-mm laparoscopic surgery in small cavities-such as in pediatric surgery-has to be evaluated in further studies.

Background Esophageal atresia (EA) is usually accompanied by some form of tracheomalacia. During the early phases in life, excessive dynamic collapse of the trachea can cause a wide spectrum of symptoms ranging from mild complaints to apparent life-threatening events (ALTE’s). Therapeutic strategies for severe tracheomalacia include aortopexy to lift the anterior weakened cartilaginous rings or posterior tracheopexy of the floppy membranous tracheal intrusion. Earlier we have introduced a new approach in which the posterior tracheopexy is performed directly during primary thoracoscopic correction of EA. Methods In the period 2017–2018, all consecutive EA patients (27) underwent a rigid tracheobronchoscopic evaluation during induction of anesthesia prior to the thoracoscopic EA repair. Tracheomalacia was diagnosed in 11 patients. During the subsequent thoracoscopic procedure, the posterior tracheal membrane was fixed to the anterior longitudinal spinal ligament with nonabsorbable sutures. The esophageal ends were then mobilized toward the right hemithorax and anastomosed. Results On preoperative RTB, six patients had a severe (66–99%) mid tracheal collapse and five patients had a moderate (33–66%) collapse. Thoracoscopic posterior tracheopexy with on to three sutures was possible in all 11 patients, prior to the formation of the esophageal anastomosis. Median time per suture was 6 minutes (range: 4–12 minutes). All operative procedures were uneventful. A median follow-up of 10 months (range: 2–22 months) revealed that eight patients recovered without any respiratory symptoms, one patient had respiratory symptoms caused by a suture granuloma that was removed by bronchoscopy, one patient had a respiratory syncytial virus bronchiolitis and one patient had a rhinovirus infection. None of the patients experienced any ALTE’s. Conclusion Eleven patients have been treated by thoracoscopic posterior tracheopexy during primary EA repair. This technique could prevent potentially deleterious sequelae of moderate to severe tracheomalacia that may complicate the lives of EA patients. Also, a second, sometimes complex surgical procedure can be prevented as the posterior tracheopexy is performed during the primary thoracoscopic EA correction.

Background Long-gap esophageal atresia (LGEA) is defined as atresia without distal tracheoesophageal fistula. Preserving the native esophagus is considered superior over intestinal interposition. Thoracoscopic traction technique facilitates lengthening of the esophageal ends, and allows anastomosis within the first weeks of life. The aim of this study was to evaluate the long-term outcome of LGEA patients treated by thoracoscopic traction technique. Methods From 2007 to 2018, 13 consecutive patients with LGEA were treated by thoracoscopic traction technique. During the first operation a bronchoscopy was performed to evaluate the presence of a proximal fistula. Then thoracoscopic traction sutures were placed at both esophageal ends. Initially a gastrostomy was performed. However, nowadays only a gastropexy is performed to prevent the stomach from migrating into the thorax. Approximation of the esophageal ends was evaluated by postoperative X-rays. Thoracoscopic adhesiolysis was performed when necessary. Both ends were anastomosed during the final surgical procedure, usually within a week. Results In 11 patients the anastomosis could be completed by thoracoscopic traction technique. In two patients the elongation procedure failed. In the first patient the sutures tore out. The second patient had an accidental perforation of the proximal pouch by the Replogle tube. Median time on ventilation until after the final anastomosis was 14 days (range 4–34 days). Five patients required chest tube drainage for anastomotic leakage. The median hospitalization time during the first admission was 47 days (range 31–170 days). All patients needed a median of 4 (range 1–16) dilatations for anastomotic stenosis. Ten patients needed a fundoplication within a median time of 8 weeks (range 2–16 weeks) after the esophageal anastomosis. One patient developed an esophago-bronchial fistula. Median weight at age of 2 years was −1.88 SD (range −3.54 – −0.16) and at age of 4 years −1.53 SD (range −2.94–0.66). All patients tolerated full oral feeding. Conclusion LGEA can be treated successfully after elongation by thoracoscopic traction technique. The procedure leads to an earlier anastomosis and shorter initial hospital stay as compared to delayed primary anastomosis. Full oral feeding is possible in all patients. Dilatation for anastomotic strictures and antireflux surgery is necessary in (almost) all patients.

OBJECTIVE The objective of this study was to assess the interobserver agreement between on-call radiology residents and radiology specialists in the evaluation of pulmonary embolism (PE) using computed tomographic pulmonary angiography (CTPA). MATERIALS AND METHODS Single center, prospective cohort study of 119 consecutive inpatients and outpatients with clinically suspected PE in whom CTPA was performed during out-of-office hours and weekends. The on-call radiology resident interpreted the CTPA for the presence of PE. An experienced radiology specialist, without knowledge of earlier reading, reviewed the CTPA the following morning. In discordant cases, a consensus reading was conducted. The radiology specialists' assessment and the consensus reading in case of discordance were considered as the gold standard. RESULTS Five CTPA studies were excluded from the analysis. In the remaining cases, radiology residents and radiology specialists agreed on the interpretations of CTPAs (no PE vs PE present) in 106 (93%) of the 114 cases, with a kappa value of 0.84 (95% confidence interval, 0.74-0.95). The consensus reading equally disagreed with both radiology resident and radiology specialist in 8 (7%) of the 114 discordant cases. Seven out of 8 discordant cases had suboptimal scan quality. CONCLUSIONS The assessment of CTPA in patients with suspected PE by radiology residents seems reliable during out-of-office hours.