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Background: Minimally invasive surgery (MIS) is increasingly adopted in pediatric surgical practice, yet it demands specific technical skills that require structured training. Simulation-based education offers a safe and effective environment for skill acquisition, especially in complex procedures such as thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA-TEF). Objective: This study aimed to evaluate the effectiveness of a 3D-printed simulator for training pediatric surgeons in thoracoscopic EA-TEF repair, assessing improvements in operative time and technical performance. Methods: A high-fidelity, 3D-printed simulator replicating neonatal thoracic anatomy was developed. Six pediatric surgeons at different training levels performed eight simulation sessions, including fistula ligation and esophageal anastomosis. Operative time and technical skill were assessed using the Stanford Microsurgery and Resident Training (SMaRT) Scale. Results: All participants showed significant improvements. The average operative time decreased from 115.6 ± 3.51 to 90 ± 6.55 min for junior trainees and from 100.5 ± 3.55 to 77.5 ± 4.94 min for senior trainees. The mean SMaRT score increased from 23.8 ± 3.18 to 38.3 ± 3.93. These results demonstrate a clear learning curve and enhanced technical performance after repeated sessions. Conclusions: Such 3D-printed simulation models represent an effective tool for pediatric MIS training. Even within a short time frame, repeated practice significantly improves surgical proficiency, supporting their integration into pediatric surgical curricula as an ethical, safe, and efficient educational strategy.

Background: Indocyanine green (ICG) fluorescence imaging has revolutionized pediatric surgery by enhancing precision, safety, and outcomes across various specialties. In recent years, its use has spread through the framework of pediatric surgery, where its ability to illuminate anatomical structures and pathological conditions has improved surgical outcomes. Methods: We conducted a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was performed using the term “Indocyanine green” in all fields, including papers about pediatric patients (aged 0–18 years) published between January 2014 and July 2024. Results: This review systematically explores ICG applications, dosing regimens, timing of administration, and integration into modern surgical technologies, including robotics and minimally invasive platforms. ICG resulted in an excellent safety profile and enables the real-time visualization of anatomical structures and pathological conditions, proving invaluable in pediatric cases characterized by smaller anatomical dimensions and congenital anomalies. Conclusions: This review highlights ICG fluorescence imaging as an indispensable tool in pediatric surgery, offering transformative potential for improving surgical outcomes and patient safety. Despite its advantages, it is necessary to standardize dosing and timing protocols to maximize its utility. The aim of this review is to explore the various applications of ICG in pediatric surgery, report the dosage and administration times across different surgical fields, and establish best practices to guide its future use.

Background: In pediatric surgery, a comprehensive knowledge of the child’s anatomy is crucial to optimize surgical outcomes and minimize complications. Recent advancements in medical imaging and technology have introduced innovative tools that enhance surgical planning and decision-making. Methods: This study explores the integration of mixed reality technology, specifically the HoloLens 2 headset, for visualization and interaction with three-dimensional (3D) anatomical reconstructions obtained from computed tomography (CT) scans. Our prospective observational study, conducted at IRCCS (Scientific Hospitalization and Care Institute) Sant’Orsola-Malpighi University Hospital in Bologna, engaged ten pediatric surgeons, who assessed three types of anatomical malformations (splenic cysts, pulmonary cystic adenomatoid malformations, and pyelo-ureteral junction stenosis) and planned surgeries using both traditional 2D CT scans and 3D visualizations via HoloLens 2, followed by completing a questionnaire to evaluate the utility of each of these imaging techniques in surgical planning. Results: The statistical analysis revealed that the 3D visualizations significantly outperformed the 2D CT scans in clarity and utility (p < 0.05). The results indicated significant improvements in anatomy understanding and surgical precision. The immersive experience provided by HoloLens 2 enabled surgeons to better identify critical landmarks, understand spatial relationships, and prevent surgical challenges. Furthermore, this technology facilitated collaborative decision-making and streamlined surgical workflows. Conclusions: Despite some challenges in ease of use, HoloLens 2 showed promising results in reducing the learning curve for complex procedures. This study underscores the transformative potential of mixed reality technology in pediatric surgery, advocating for further research and development to integrate these advancements into routine clinical practice.

Purpose: Acute appendicitis (AA), classified as non-complicated acute appendicitis (NCAA) and complicated acute appendicitis (CAA), is the most common cause of abdominal pain in children requiring surgical treatment. If the first-line treatment for NCAA is to be debated between conservative management and surgery, authors find a consensus in choosing surgery as the first step for CAA in children. In the case of patients with CAA undergoing surgery, a broad-spectrum antibiotic therapy should be administered to reduce the risk of post-operative complications (POC). The rise in antibiotic resistance requires a review of recent data regarding bacterial species involved in AA. The primary aim of our study was to investigate the clinical effectiveness of different antibiotic protocols in patients undergoing surgery for CAA. The secondary aim was to verify the antibiotic’s in vitro effectiveness based on cultural examinations. Methods: A retrospective and prospective study was conducted on all patients operated on at our pediatric surgery department for CAA from January 2017 to January 2023. The following data were collected: age at surgery, sex, surgical technique, duration of the procedure, antibiotic therapy, duration of the hospital stay, cultural examination of peritoneal effusion, and POC. Results: We divided the patients enrolled (n = 182) into three groups of antibiotic protocols; only one group resulted in a statistically significant lower rate of POC. Different pathogens were isolated (Enterobacteriaceae, non-fermentative Gram-negative bacilli, anaerobes, Gram-positive cocci), and the in vitro rate of antimicrobial sensitivity varied from 40% to 94% in the three groups of patients. Conclusions: Based on cultural examinations, our study showed a high rate of inadequacy regarding the therapy with amoxicillin + clavulanic acid despite a low rate of complications. Radical surgery seems to be the best way to reduce complications in children with CAA.

Platelet-Rich Plasma (PRP) therapy has become a promising treatment option in pediatric surgery, offering a novel approach to tissue repair and regeneration. Obtained from the patient’s own blood or umbilical cord blood (CB), PRP is a concentrated form of plasma enriched with platelets, growth factors, and cytokines essential for stimulating tissue healing. This systematic review explores the applications of PRP therapy in pediatric surgical procedures, focusing on its role in promoting wound healing, reducing postoperative complications, and enhancing patient outcomes. A systematic literature overview was conducted in accordance with PRISMA guidelines, encompassing studies published between 2004 and 2024. The research has identified different fields of application for PRP therapy in pediatric surgery, including treatment of pilonidal sinus and hypospadias repair. Key findings from clinical studies and randomized controlled trials are summarized, highlighting the efficacy of PRP therapy in accelerating wound healing, reducing pain, and improving patient recovery. Despite promising results, challenges and controversies surrounding PRP therapy persist, including variability in preparation protocols and optimal dosing regimens. The safety of PRP therapy in pediatric patients is also discussed, emphasizing its autologous nature and minimal risk of adverse reactions. In summary, this review highlights the role of PRP therapy as a safe and effective therapeutic approach in pediatric surgery, while further research to standardize protocols and elucidate optimal treatment strategies are still necessary.

Postoperative management of esophagocutaneous fistulas in pediatric patients is challenging, often resulting in prolonged hospitalization and increased morbidity. Platelet-rich plasma (PRP) has emerged as a promising adjunctive treatment for such complications. We present the case of a 7-month-old infant who developed an esophago-cutaneous fistula following esophagocoloplasty for esophageal atresia type A. Despite initial conservative management, the fistula persisted, prompting the application of PRP gel derived from umbilical cord blood. After four applications of PRP, complete closure of the fistula was achieved, leading to both functional and aesthetic results. This case highlights the potential of PRP in managing refractory postoperative esophageal fistulas in pediatric patients and underscores the need for further research to optimize treatment protocols and validate its efficacy for this sort of complications

Background: Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI’s management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific variables that must be considered in the pediatric age range (e.g., age of patients and neuropsychiatric disorders) in addition to the mere characteristics of the foreign body. We present an application for smartphones designed for pediatricians and pediatric surgeons based on the latest guidelines from the official pediatric societies. The app aims to help physicians manage FBI quickly and properly in children. Materials and methods: The latest pediatric FBI management guidelines were reviewed and summarized. The flow chart we obtained guided the development of a smartphone application. A questionnaire was administered to all pediatric surgeon trainees at our institute to test the feasibility and helpfulness of the application. Results: An app for smartphones was obtained and shared for free on the Google Play Store and Apple Store. The app guides the physician step by step in the diagnostic process, analyzing all patient- and foreign body-specific characteristics. The app consultation ends with a suggestion of the most proper decision to make in terms of further radiological investigations and the indication and timing of endoscopy. A questionnaire administered to trainees proved the app to be useful and easy to use. Conclusion: We developed an app able to help pediatricians and pediatric surgeons manage FBI in children, providing standardized and updated recommendations in a smart and easily available way.

Ultrasound (US) is a non-invasive imaging technique frequently used to examine internal organs and superficial tissues, and invaluable in pediatric patients. In a surgical setting, intraoperative ultrasound allows to highlight anatomical structures in detail during traditional open and minimally invasive surgery, thanks to the use of specific probes. In fact, laparoscopic and robotic ultrasonography requires the development of specialized transducers that fit through laparoscopic trocars. In adults, laparoscopic ultrasound is used during cholecystectomy before dissection of the triangle of Calot, to guide liver biopsies and ablation procedures and for the staging of patients with pancreas adenocarcinoma. However, the applications in the pediatric field are still limited. This paper aims to share our preliminary experience with ultra-sound in minimally invasive laparoscopic and robotic pediatric surgery, describing two cases in which intra-operative ultrasound was applied, and to present a review of the literature on the state of the art of the actual uses in pediatric surgery.

Background: The diagnosis of acute appendicitis (AA) remains challenging, especially in pediatrics, because early symptoms are not specific, and the younger the patient the more difficult their interpretation is. There is a large degree of agreement between pediatric surgeons on the importance of an early diagnosis to avoid complicated acute appendicitis (CAA) and its consequences. The aim of this study is to assess if Interleukin 6 (IL-6) could enhance the sensitivity (Sn) and specificity (Sp) of the currently available and routinely performed diagnostic tools in case of suspected AA in pediatric patients. Materials and Methods: A prospective observational study was conducted including patients who underwent appendectomy between November 2020 and March 2022. We divided patients into three groups: not inflamed appendix (group NA), not complicated AA (group NCAA), and complicated AA (group CAA). We compared the mean values of white blood cells (WBC), neutrophils, fibrinogen, ferritin, aPTT, INR, C-reactive protein (CRP), IL-6, and CRP between the three groups. Then we evaluated Sn, Sp, and odds ratio (OR) of IL-6 and CRP alone and combined. Results: We enrolled 107 patients operated on for AA (22 in Group NA, 63 in Group NCAA, and 21 in group CAA). CRP levels resulted in a significant increase when comparing CAA with NA (p = 0.01) and CAA with NCAA (p = 0.01), whereas no significance was found between NA and NCAA (p = 0.38). A statistically significant increase in average IL-6 levels was found when comparing NCAA with NA (p = 0.04), CAA with NA (p = 0.04), and CAA with NCAA (p = 0.02). Considering CRP alone, its Sn, Sp, and OR in distinguishing NA from AA (both NCAA and CAA together) are 86%, 35%, and 33,17, respectively. Similarly, Sn, Sp, and OR of IL-6 alone are 82%, 54%, and 56, respectively. Combining CRP and IL-6 serum levels together, the Sn increases drastically to 100% with an Sp of 40% and OR of 77. Conclusions: Our study may suggest an important role of IL-6 in the detection of AA in its early stage, especially when coupled with CRP.