J. Tashiro1, N. Joudi1, E. A. Perez1, J. E. Sola1 1University Of Miami,Surgery,Miami, FL, USA
Introduction: Minimally invasive surgery has been introduced for a multitude of indications in pediatric surgery. We hypothesized that the use of laparoscopy and thoracoscopy in pediatric surgery is dependent on the complexity of the procedures performed.
Methods: The Kids’ Inpatient Database (1997-2012) was searched for basic (appendectomy, cholecystectomy) and advanced (pull-through rectal resection, lung resection) procedures.
Results: Overall, 583,738 cases were included in the study cohort, performed laparoscopically/thoracoscopically (52%) or open (48%).
Appendectomies (n=500,708) were more frequently performed open (53%) overall, with the remainder were performed laparoscopically (47%). The study period saw an overall increase in the use of laparoscopy from 13% to 81%, p<0.001. A significant increase in the use of laparoscopy was observed over each triennial period, p<0.001. Rates of conversion to open surgery has declined steadily from 5.9% in 2000 to 2.1% in 2012, p<0.001. Incidence of appendectomies also rose, from 1058 to 1164 cases per 100,000 admissions, p<0.001.
Cholecystectomies (n=78,576) were mostly performed laparoscopically (88%), whereas the remainder were performed open (12%). Over the study period, laparoscopy rates increased from 76% to 92%, p<0.001. The triennial periods between 1997 and 2009 were found to increase significantly in the laparoscopy rate, p<0.001; the rate has since reached a plateau between 2009 and 2012. Conversion rates have declined recently, falling from 3.0% in 2006 to 2.0% in 2012, p<0.02. Incidence of cholecystectomy has increased through each triennial period, from 114 to 211 cases per 100,000 admissions, p<0.001.
Pull-through procedure (n=2895) for Hirschsprung’s disease were most frequently performed open (78%), whereas the remainder were performed laparoscopically (22%) between 2009 and 2012. During this period, the rate of laparoscopy increased from 19% to 24%, p=0.001. Conversion and incidence rates were static.
Lung resections (n=1559) for congenital pulmonary airway malformation (748.4) and pulmonary sequestration (748.5) were most frequently performed open (64%); the remainder were performed thoracoscopically (36%) between 2009 and 2012. The rate of thoracoscopic surgery has increased in this period from 24% to 41%, p=0.001. Conversion rates decreased from 8.5% to 4.9%, p<0.001. Case incidence rose from 6 to 17 cases per 100,000 admissions, p<0.001.
Conclusion: The introduction of minimally invasive surgery has had a significant impact on both basic and advanced pediatric surgery procedures. Declining minimally invasive to open conversion rates may demonstrate increasing familiarity with laparoscopy/thoracoscopy for difficult cases.
