Sanjeev Dutta

Surgical innovation involves the conceptualization, research, and translation of a novel idea into a viable procedure or device. The technological advancements made within the field of pediatric surgery over the last century have led to major improvements in patient care and outcomes. There has, however, been a parallel increase in the complexity of the regulatory bodies governing research and device implementation. This article briefly outlines the history of innovation in pediatric surgery, describes the existing regulatory bodies governing surgical research and device development (i.e., Department of Health and Human Services, Food and Drug Administration), and offers a set of guidelines for the pediatric surgeon planning to incorporate a new procedure or device into clinical practice.

The development of surgical robotics is a dynamic process, a constant interplay between clinical need and technologic capability. As both of these factors are constantly changing, it is unlikely that the form the surgical robot takes today will be the form it takes in 20 years. In many aspects, the technology has progressed beyond perceived clinical need. This has created a novel challenge for the surgeon — to determine whether a technologic innovation with apparent benefit has meaningful clinical application. This process has defined the in corporation of robotic technologies into many surgical disciplines, including gynecologic, cardiothoracic, urologic, abdominal, and pediatric surgeries. In whatever way this interplay of technology and clinical need progresses, surgeons are left with the task of guiding its impact on patient care.The term robot is a misnomer when describing this surgical device. Derived from the Czech robota meaning “drudgery,” this term implies autonomous function, which most surgical robots do not have. Instead, they are better described as computerassisted telemanipulators, implying that they are subject to human control. The complexity of surgical procedures does not currently allow for devices that work entirely autonomously. Nevertheless, the term robot has added a flare of futurism to the endeavor and has been the one most commonly used in the literature.

Inguinal hernia in children is traditionally repaired through a groin incision by dissecting the hernia sac from the spermatic cord and suture ligating its base. A laparoscopic modification of this procedure involves placement of a transcutaneous suture around the neck of the sac through a 2-mm stab incision under visualization with an umbilically placed 2.7-mm 30^o lens. We reviewed the clinical outcome of this novel procedure at our institution. Prospective review of 275 hernias in 187 children (144 male, 43 female) performed laparoscopically by a single surgeon between September, 2002 and June, 2005. Data analyzed included side of hernia, incarceration, prematurity, recurrence rate, and complications. 30 left, 69 right, and 25 bilateral hernias were repaired. Sixty-three unilateral hernias had a contralateral patent processus vaginalis that was repaired. Mean operative time for a bilateral repair was 17 min. Two procedures were for recurrence after open repair. Forty-nine patients were ex-premature infants, accounting for 79 repairs. Fifteen cases followed reduction of incarcerated hernias, nine of whom were in preterm infants. Four out of 275 hernias (1.5%) recurred in four patients (mean age 4.5 years; 3 male, 1 female). There were four superficial wound infections, two umbilical granulomas, two hydroceles, and six self-resolving hematomas. There were no spermatic cord injuries, testicular atrophy, or symptoms of ilioinguinal nerve injuries. This novel laparoscopic inguinal hernia repair is an effective method in children, with recurrence rates comparable to the traditional approach. Advantages of the laparoscopic operation include a “no-touch” approach to the spermatic cord structures, a virtually virgin operative field in cases of recurrence, and excellent cosmesis. Disadvantages include peritoneal access and nonhermetic seal in males.

Research from JAMA Pediatrics — Multiple Magnet Ingestion as a Source of Severe Gastrointestinal Complications Requiring Surgical Intervention