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Background: Advancements in artificial intelligence (AI) and machine learning (ML) are set to revolutionize healthcare, particularly in fields like endoscopic surgery that heavily rely on digital imaging. However, to effectively integrate these technologies and drive future innovations, pediatric surgeons need specialized AI/ML skills. This survey evaluated the current level of readiness and educational needs regarding AI/ML among members of the European Society of Pediatric Endoscopic Surgeons (ESPES). Methods: A structured survey was distributed via LimeSurvey to ESPES members via email before and during the 2024 Annual Conference. Responses were collected over four weeks with voluntary, anonymous participation. Quantitative data were analyzed using descriptive statistics. Results: A total of 125 responses were received. Two-thirds (65%) of respondents rated their AI/ML understanding as basic, with only 6% reporting advanced knowledge. Most respondents (86%) had no formal AI/ML training. Some respondents (31%) used AI/ML tools in their practice, mainly for diagnostic imaging, surgical planning, and predictive analytics; 42% of the respondents used these tools weekly. The majority (95%) expressed interest in further AI/ML training, preferring online courses, workshops, and hands-on sessions. Concerns about AI/ML in pediatric surgery were high (85%), especially regarding data bias (98%). Half of respondents (51%) expect AI/ML to play a significant role in advancing robotic surgery, oncology, and minimally invasive techniques. A strong majority (84%) felt that the ESPES should lead AI education in pediatric surgery. Conclusions: This survey presents the ESPES with a unique opportunity to develop a competency map of its memberships AI/ML skills and develop targeted educational programs, thus positioning the society to take the lead in AI education and the advancement of AI solutions in pediatric endosurgery.

INTRODUCTION: The incidence of pediatric Wilms tumor (WT) is high in Africa, though patients abandon treatment after initial diagnosis. We sought to identify factors associated with WT treatment abandonment in Uganda. METHODS: A cohort study of patients  25 cm (OR 2.67, 95% CI 1.05-6.81). CONCLUSIONS: Children with WT in Uganda frequently abandon care during neoadjuvant therapy, particularly those with large tumors with poor response. Further investigation into the factors that influence treatment abandonment and a deeper understanding of tumor biology are needed to improve treatment adherence of children with WT in Uganda.

As pediatric and adult operative mortality improves, longitudinal outcomes beyond survival become increasingly important. "Days alive and out of hospital" is well-studied as a longitudinal, patient-centered outcome in adult populations. However, it has yet to be validated for children, whose health care use and survival differ from that of adults. This study sought to evaluate days alive and out of health care/hospital as outcomes for neonatal and infant cardiac surgery. Using linked, locally held, clinical registry data, the National Death Index, and Medicaid claims from the CHS-COLOUR (New York Congenital Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources), we describe and compare the distribution of days alive and out of health care/hospital (730 days or date of death minus date of birth, minus the sum of days in health care) over 2 years for New York State Medicaid-enrolled children who underwent initial neonatal or infant cardiac surgery during 2006 to 2018. We assess relative contributions of mortality, inpatient, and outpatient days, test impacts of alternate outpatient day weightings, and assess associations with patient characteristics known to be associated with other, established congenital heart surgical outcomes. In total, 2,519 Medicaid-enrolled neonates/infants underwent initial cardiac surgery in the first year of life across New York state during 2006 to 2018. Days alive and out of health care (DAoH) (0-730 days) was bimodally distributed, with 10.4% (n = 261) spending <100 days and 21.6% (n = 545) spending >700 DAoH. We found that 5.9% (n = 149) of children died during their birth admission (0 DAoH). Cardiac disease complexity, weight at surgery, noncardiac preoperative comorbidities, and other preoperative risk factors were all significantly associated with the outcomes (P <0.001). When considering only inpatient days, the distribution was more left-skewed, because 40% of health care days in the second year of life was attributable to outpatient days. Our findings were otherwise largely insensitive to health care type weightings. In this data set of children with Medicaid coverage, total DAoH is an easily reproducible, patient-centered outcome that should be considered for assessment of longitudinal outcomes for neonates and infants undergoing cardiac surgery. Where outpatient data are not available, days alive and out of hospital might serve as a reasonable alternative. [Display omitted] [ABSTRACT FROM AUTHOR]

The 2023 National Clinical Database Annual Report by the Japan Surgical Society presents detailed data on surgical procedures performed in Japan, covering various categories such as breast surgery, general thoracic surgery, cardiovascular surgery, peripheral vascular surgery, surgery of the head and neck/body surface/endocrine system, and pediatric surgery. The report reveals that approximately 2.63 million cases were registered in 2023, totaling around 28.48 million cases. It highlights the most common procedures in each category, such as sentinel lymph node biopsy for breast malignancy, thoracoscopic lobectomy for malignant lung tumors, and stent grafting of the abdominal aorta. The data offers valuable insights into the prevalence of different surgical procedures in these medical fields, reflecting a wide range of surgical interventions. [Extracted from the article]

Shoulder external rotation after brachial plexus birth injury can be restored by transfer of the spinal accessory nerve to the suprascapular nerve, or more distally to its infraspinatus branch. We studied the outcome of these nerve transfers in 52 patients with a minimum postoperative follow-up of 12 months (mean 7.3 years). The median postoperative improvement in shoulder external rotation was 120° (interquartile range [IQR] 45–135) after anterior and 110° (IQR 83–120) after dorsal spinal accessory nerve transfer to the suprascapular nerve main trunk, and 110° (IQR 80–125) after transfer to the infraspinatus branch. Patients operated after 20 months obtained external rotation ≥90° less frequently. The results of this study suggest that a decision about distal nerve transfer for shoulder external rotation is recommended at 1.5 years of age. Level of evidence: III [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery after surgery (ERAS) pathways has become well established for operations as diverse as hip replacement and coronary artery bypass. We designed an ERAS gastrostomy pathway in children based on best practice to facilitate 23-h discharge. Methods: An ERAS pathway for laparoscopic Seldinger gastrostomy insertion was developed in 2018 with standardisation of all phases from first pre-operative visit to discharge. A series of videos uploaded to YouTube accessed via a QR code were created to educate parents. The post-operative feeding regime, nurse-led training and discharge plan were standardised on a single page so it could be shared and viewed easily on a smart phone. Results: Data were collected prospectively for isolated elective laparoscopic gastrotomy insertion from 2019 to 2022. A total of 155 patients were eligible for the ERAS gastrostomy pathway (median age: 3.9 years; median co-morbidities: 4). Length of post-operative stay was a median 26 h with 60/155 (39%) of patients leaving by 10 am the next morning. Post-operative complications were noted in 20 patients with 6 readmissions none of which were due to early discharge. Multiple non-clinical reasons were identified for delays to discharge. Conclusions: Multiple major co-morbidities were not a contraindication to following the ERAS. In total, 39% of the patients were discharged by 10 am the next morning. Key to success was having a single surgical technique, standardisation of pre- and post-operative pathways and nurse-led discharge. Further improvements should be possible by closer adherence to the guidelines. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to explore the feasibility and effect of pulmonary rehabilitation (PR) in the recovery of children who underwent thoracoscopic pulmonary resection. Methods: From January 2015 to December 2021, consecutive patients who underwent thoracoscopic pulmonary resection were divided into group A and group B. All of them were treated with the same perioperative protocols except for group A with perioperative lung rehabilitation management, while group B was not. Demographics, operative data, postoperative complications and clinical outcomes were compared between these two groups. Results: Sixty eight cases enrolled with 33 in group A and 35 in group B. Demographic data was comparable between the two groups, as well as the dose of tramadol and diclofenac sodium. Few patients in group A had temperature higher than 38℃ in the first 3 days after the surgery. The mean time of the first ambulation after the operation was shorter in group A than that in group B. The drainage time and the postoperative hospital stay were similar. No interventions needed for complications. Conclusion: The application of perioperative PR in children who underwent thoracoscopic pulmonary resection is safe and feasible. [ABSTRACT FROM AUTHOR]

Background: Effective pain management in pediatric cardiac surgery is essential for optimizing postoperative outcomes and promoting faster recovery. While intravenous analgesia remains a standard approach, regional anesthesia (RA) techniques have gained attention in this population due to their analgesic efficacy, reduced dependence on systemic opioids, and enhanced hemodynamic stability. Main Body: This article provides an overview of current evidence of RA techniques for pediatric cardiac surgery. We discuss the role of RA in pediatric pain management, outlining various techniques, such as epidural, paravertebral block, fascial plane blocks and their specific applications, clinical outcomes, and the challenges posed by pediatric anatomy and pharmacokinetics. Pain assessment in pediatric populations and the complications associated with RA are also explored. Conclusion: Despite the demonstrated efficacy of RA in this patient group, there is a need for large-scale randomized multicenter studies to establish standardized protocols and strengthen the evidence base for its use in pediatric cardiac surgery. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultsConclusion\nIMPLICATIONS FOR REHABILITATIONDevelop and user-test a patient decision aid about selective dorsal rhizotomy (SDR) surgery for carers of children with cerebral palsy (CP) and clinicians treating children with CP.This study utilised a mixed-methods design. Stage One developed the prototype. Stage Two recruited carers and clinicians to focus groups/semi-structured interviews to review the prototype. Stage Three was an iterative cycle of redrafts based on feedback from Stage Two and input from the SDR Advisory and Consumer Groups. Stage Four assessed acceptability of the SDR Decision Aid via questionnaire.A prototype SDR decision aid was developed and reviewed by 13 clinicians and 8 carers. Five themes were identified: (1) positive and (2) constructive feedback on the presentation; and additional information considered important for future end-users regarding (3) rehabilitation, (4) lived experience, and (5) selection processes. The final version of the SDR Decision Aid was rated highly acceptable by carers and clinicians, based on length, amount of information provided, and usefulness in clinical settings. Participants indicated they would recommend the decision aid to others seeking information about SDR.The SDR Decision Aid is an acceptable and valuable tool for helping parents discuss SDR as a treatment option with their clinicians.Selective dorsal rhizotomy (SDR) is a neurosurgical procedure performed to reduce spasticity in the lower limbs of children with bilateral spastic cerebral palsy (CP).There are limited accessible, evidence-based, reliable resources to educate families and clinicians about SDR in Australia.This gap was addressed through a co-design process to develop an SDR Decision Aid.Acceptability testing found that the SDR Decision Aid is an acceptable and valuable tool in initiating discussions to facilitate shared decision-making about SDR as a treatment option for children with CP.Selective dorsal rhizotomy (SDR) is a neurosurgical procedure performed to reduce spasticity in the lower limbs of children with bilateral spastic cerebral palsy (CP).There are limited accessible, evidence-based, reliable resources to educate families and clinicians about SDR in Australia.This gap was addressed through a co-design process to develop an SDR Decision Aid.Acceptability testing found that the SDR Decision Aid is an acceptable and valuable tool in initiating discussions to facilitate shared decision-making about SDR as a treatment option for children with CP. [ABSTRACT FROM AUTHOR]

Background: Hemofiltration during and after cardiopulmonary bypass (CPB) reduces levels of proinflammatory cytokines and total interstitial body water. Because of economic causes, hemofilters became less available in low- and middle-income countries, which forced the perfusionists to use hemodialyzers instead. This study aimed to assess the clinical outcomes of pediatric patients who had hemodialyzers instead of hemofilters during CPB. We performed a retrospective cohort study of 46 pediatric patients who underwent cardiac surgery between January 1st, 2023, and September 30th, 2023. Patients included were those who required hemofiltration during CPB. Results: The median age and weight were 0.95 years [0.28, 2.76] and 7.5 kg [5.2, 13.6], respectively. Tetralogy of Fallot repair represented 24% of cases. CPB and aorta cross-clamp times averaged 93.0 ± 32.6 min and 60.1 ± 24.2 min, respectively. The overall mortality rate was 6.5% (n = 3). Among the deceased, all had RACHS-1 (Risk Adjustment in Congenital Heart Surgery) score 4. Mortality in the deceased group was linked to several significant factors compared to the survivors, including, lower CPB temperature (28 °C vs. 32 °C), higher lactate levels (2.9 ± 0.9 vs. 1.9 ± 0.7 mmol/L), longer mechanical ventilation duration (288 vs. 21 h), and prolonged Intensive Care Unit stay (12 vs. 3 days). CPB time, aorta cross-clamp time, or post-CPB hematocrit did not significantly differ between survived and deceased patients. Conclusions: In this retrospective analysis of 46 pediatric patients, the use of hemodialyzers for hemofiltration during CPB could be safe with acceptable mortality rate. While these preliminary findings are promising, the sample size and retrospective design limit generalizability. Further prospective studies with larger cohorts are warranted to more effectively evaluate the safety and efficacy of hemodialyzers as an alternative to hemofilters. [ABSTRACT FROM AUTHOR]

Purpose: Gangliogliomas are rare, slow-growing brain tumors frequently associated with seizures in pediatric patients. This study evaluated the utility of high-field intraoperative magnetic resonance imaging (ioMRI) in the surgical management of ganglioglioma-related drug-resistant epilepsy in children. Specifically, it sought to determine whether ioMRI improves outcomes by optimizing the extent of resection, enhancing seizure control, reducing reoperations, and minimizing complications. Methods: This retrospective single-center study included 14 pediatric patients with cerebral ganglioglioma who underwent epilepsy surgery with ioMRI from 2014 to 2022. The median age was 11.5 years (range 3–16 years). Patient demographics, the rate of continued ioMRI-guided surgery, the extent of resection, histology, complications, reoperations, and seizure outcomes at 1 year postoperatively were assessed. Results: Residual tumor was detected using ioMRI in 9 of 14 patients (64.3%), leading to further resection. Complete tumor resection was achieved in 12 patients (100%) as intended, while two patients underwent planned tumor debulking. Temporary neurological deficits were observed in two patients, with no permanent deficits documented. One patient required reoperation, and another was scheduled for one. The median follow-up duration was 43 months (range 12–65 months). Seizure outcomes were classified as Engel I in 9 of 10 (90%) and Engel III in 1 of 10 patients (10%). Four patients were lost to follow-up. Conclusion: The use of ioMRI in pediatric epilepsy surgery for ganglioglioma facilitated more complete resections, contributing to favorable seizure outcomes and a low complication rate. These findings support ioMRI as a valuable tool in optimizing surgical management for this patient population. [ABSTRACT FROM AUTHOR]

The larynx of children and adolescents is still in the developmental phase and the anatomical structure is still very small and sensitive. The higher malignancy and faster progression of some paediatric thyroid cancers make surgery more difficult. Intraoperative neuromonitoring (IONM) is frequently used in thyroid surgery as an effective means of securing the recurrent laryngeal nerve (RLN). Little information is available on the clinical efficacy of IONM in paediatric surgery. In addition, classic IONM techniques such as reinforced tracheal tube models with integrated surface electrodes are not standardised for children and adolescents. The use of innovative devices such as laryngeal masks with surface electrodes and thyroid cartilage receiving electrodes could replace monitoring tubes as a new form of IONM. Tracheal intubation in children needs to be performed by a highly experienced anaesthetist. The continued maturation of AI technology could be attempted in the future in conjunction with IONM to further reduce RLN injuries in children and adolescents. This article describes the anatomical features of the paediatric larynx, which differ from those of adults, and the advantages and shortcomings of IONM techniques for thyroid surgery in this population. The use of IONM in paediatric surgery is a complex technique and should be performed by experienced thyroid surgeons with in-depth IONM training. The use of IONM should be standardised within the clinical parameters of children. [ABSTRACT FROM AUTHOR]

Introduction: Surgical procedures in children involve significant psychological traumatic stress leading to the development of psychologic distress and dysfunction after surgery. Pediatric medical traumatic stress (PMTS) ensues from negative medical experiences which is a trauma that can have a devastating effect on children and their families. Awareness and early identification are important to provide psychological intervention at the correct time. Aims and objectives: This study aims to determine the prevalence of PMTS along with the associated surgical and psychosocial factors involved in pediatric surgical patients at our institute. Methods: We included patients admitted to the pediatric surgery ward, for elective or emergency surgeries, and a three-point assessment was done. It was done pre-surgery, at 1 month for diagnosis of PMTS, and at 3 months for any spontaneous resolution. Along with we recorded data regarding surgical and psychosocial factors in play for each child. Results: A PMTS prevalence of 16.26% was seen in the age group of 1 to 7 years and 12.64% in 8 to 18 years on evaluation at 1 month after surgery. A significant association was calculated with factors like duration of surgery, duration of hospital stay, staged approach of surgery, malignancy or congenital anomalies, postoperative pain, postoperative complications, multiple admissions, creation of stoma, need for additional interventions on follow-up, parental anxiety, and socioeconomic status. A significant spontaneous resolution at 3 months was also noted. Conclusion: With this study we can establish a significant prevalence of PMTS in pediatric patients undergoing surgery and the significantly associated determinants have been identified. The healthcare team as a whole can work toward reducing the risk of the development of PMTS, both in parents and children. Level of evidence: Level II. [ABSTRACT FROM AUTHOR]

Purpose: A predictive index for surgical complications in pediatric patients is lacking in the current scientific literature. We have developed a simple index to accurately predict the likelihood of complications after surgery. The Surgical Complication Index for Pediatric Patients (SCIPP) is reliable and accurate for both heterogenous and specific groups of pediatric patients. Methods: A retrospective analysis of pediatric neurosurgical procedures from 2005 to 2023 was conducted. Logistic and linear regression analyses were performed to analyze the correlation with their respective SCIPP scores and post-operative complications and length of stay (LOS). Results: Our cohort included 90 tethered cord patients and 43 surgeries consisting of craniotomies/craniectomies, laminectomies/laminotomies, and others. The mean SCIPP score across all 133 patients was 2.41 ± 1.76, with an average age of 5.37 ± 5.53 years. From the logistic regression, each 1-point increase in SCIPP score was associated with increased odds of experiencing a complication after surgery in all patients (odds ratio: 1.57; p < 0.001) and tethered cord patients (odds ratio: 1.59; p = 0.007). The reduced 4-point SCIPP was associated with increased odds in all patients (odds ratio: 2.67; p < 0.001) and tethered cord patients (odds ratio: 2.89; p = 0.001) as well. Upon linear regression analysis, each 1-point increase in SCIPP was associated with a 0.49 day increase in LOS (p = 0.002). Each 1-point increase in reduced SCIPP was associated with a 0.42 day increase in LOS but was not statistically significant (p = 0.120). Conclusion: The SCIPP is a simple and accurate tool that predicts surgical complications and LOS in a variety of pediatric neurosurgical procedures and can be used to counsel patients and families on the risks of surgery. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric surgery training in Germany faces significant challenges related to structural issues and resource limitations, including variability in training sites and a lack of standardized oversight. This study aims to assess the current state of pediatric surgery training including its structure, quality, and resident satisfaction and identify areas for improvement. Materials and methods: We conducted an online survey between May 2022 and November 2023 using single-choice, multiple-choice and open-ended questions. Additionally, information was gathered via analysis of available statistics and through direct contact with the State Chambers of Physicians. Results: 75 pediatric surgery residents and 15 young specialists participated in the survey. 12 of 17 state medical chambers responded to our inquiry, but only 4 maintain detailed statistics. Training often extends beyond the planned six years, mainly (75%) due to insufficient surgical exposure. Residents reported a predominant role of attendings in surgical training and other residents in clinical training. They desired more involvement from chiefs in their education. A significant proportion (58.9%) noted a lack of dedicated scientific education. Nearly half (44.4%) of the respondents had changed training sites, primarily due to clinical rotations (26,7%) and dissatisfaction with training conditions (30,0%). Conclusion: Pediatric surgery residents in Germany face inconsistent training quality and extended training periods, mainly due to insufficient surgical exposure. They report that some chiefs do not meet their obligations as trainers adequately. To address these issues, there is a need for enhanced oversight, standardized curricula, more surgical exposure and improved collaboration among training institutions. [ABSTRACT FROM AUTHOR]