Efficacy of robot-assisted thoracoscopic surgery in the treatment of pulmonary sequestration in children

Objective This study was performed to evaluate the efficacy of robot-assisted thoracoscopic surgery(RATS)in the treatment of pulmonary sequestration(PS)in children.Methods All video-assisted thoracoscopic surgery(VATS)and RAST performed on patients with PS at a single center from May 2019 to July 2023 were identified.The x2 and Wilcoxon tests were used to compare the perioperative outcomes between VATS and RATS groups.Results Ninety-three patients underwent RATS while 77 patients underwent VATS.In both two groups,one patient converted to thoracotomy and no surgical mortality case.The median operation time was longer for the RATS group compared with the VATS group(75 min vs.60 min,p<0.001).A lower ratio of chest tube indwelling(61.3%vs.90.9%,p<0.001),fewer drainage days(1.0 day vs.2.0 days,p<0.001),and a shorter postoperative length of stay(5.0 days vs.6.0 days,p<0.001)were found in the RATS group than that in the VATS group.No significant difference was found in the incidence of short-term postoperative complications(hydrothorax and pneumothorax)between two groups.Conclusions RATS was safe and effective in children with PS over 6 months old and more than 7 kg.Furthermore,RATS led to better short-time postoperative outcome than VATS.Multi-institutional studies are warranted to compare differences in long-term outcomes between RATS and VATS.

Screening for congenital heart defects: diversified strategies in current China

background Congenital heart defects(CHD)is the most common type of birth defect and a leading cause of infant mortality in China.Detection of CHD during newborn is still challenging.The contradiction between the increasingly mature technology of diagnosis and treatment and the inability of early detection is the biggest current dilemma.A few pilot studies attempt to establish the universal screening for CHD in newborns;however,the rate of misdiagnosis is still high in most Chinese hospitals,especially in some undeveloped middle-western regions.Data sources Based on the recent publications on screening of congenital heart diseases in China.We reviewed the use of diversified screening strategies in current China.results Prenatal diagnosis by fetal echocardiography and postnatal detection by pulse oximetry combined with clinical assessment are the useful methods for CHD screening in most areas.The altitude should be taken into account when using pulse oximetry in the middle-western areas of China,where the incidence of CHD maybe higher.Echocardiography is suitable for CHD screening in almost all areas but it could add to financial burden in the developing regions.Genetic analysis could assist clinical doctors to perform more earlier screening and give better counseling regarding the outcome.Due to disparities in economic and medical resources,the screening system should be carried out from multiple perspectives according to the present economic development.Notably,follow-up is an important issue in the screening of CHD,especially for the asymptomatic babies who discharged home.Policies should be formulated to address the epidemiology of CHD in deprived areas to better allocate medical resources and to develop local training programmes to screen and diagnose CHD.Conclusions Diversified strategies are available in current China.The two-indicator method for CHD screening is recommended to be implemented in routine postnatal care.We can do more in screening for CHD in the future.

Lessons learned from ECMO support in pediatric patients with D-transposition of the great arteries:preoperative,intraoperative and postoperative

Background Extracorporeal membrane oxygenation(ECMO)support on D-transposition of the great arteries(D-TGA)carries formidable challenges.Methods A retrospective study was performed on pediatric patients with D-TGA supported by ECMO from July 2007 to December 2019.This study summarized the clinical experience of ECMO support in pediatric patients with D-TGA preoperative,intraoperative,and postoperative.Results Overall,16 children with D-TGA received ECMO support during this period.Two(2 of 16)were supported before cardiac surgery,3(3 of 16)were supported postoperatively in the intensive care unit,and 11(11 of 16)failed to wean off cardiopulmonary bypass.Two cases of preoperative ECMO support for patients with D-TGA with an intact ventricular septum and restrictive atrial septum due to severe hypoxemia died.In this study,D-TGA with coronary artery malformation and other complicated deformities died(8 of 14),whereas uncomplicated D-TGA without coronary artery malformation all survived(6 of 14).The wean-off rate of ECMO patients supported in D-TGA was 62.5%(10 of 16),while the 30-day survival rate was 44%(7 of 16).Conclusion Although a promising ECMO weaning rate was obtained,30-day survival of this population was frustrating,mainly attributed to the original anatomy of coronary arteries and the concomitant deformities.