Articles

Small bowel magnetic compression anastomosis creation for bypass procedures in a porcine model. [1]Olavarria OA et al., Surg Endosc. 2025 Mar;39(3):2155-2163. Epub 2025 Feb 4. PMID: 39904790.

While stapled and hand-sewn techniques are commonly used to perform bowel anastomoses, they have flaws. The GI Windows Flexagon system uses a hexagon of self-forming magnets to create a bowel anastomosis, although this system is not well tested.

In a preclinical study on 14 Yorkshire swine, the GI Windows Flexagon system along with the OTOLoc device to assist with implantation was used to create 8 bowel anastomoses and compare these to 6 swine who underwent a standard stapled anastomosis. The anastomoses were then compared with regards to adhesions, histopathologic findings, and burst pressure among other things. It was found that the magnet-derived anastomoses had less adhesions/inflammation, higher burst pressures, and less distortion than the stapled anastomoses. Additionally, all animals successfully passed the magnets after the anastomosis was complete.

Iterative Design and Manufacturing of a 3D-Printed Pediatric Open and Laparoscopic Integrated Simulator for Hernia Repair (POLISHeR). [2]Fuchs J et al., Pediatr Blood Cancer. 2024 Dec;71(12):e31339. Epub 2024 Sep 27. PMID: 39334537.

Inguinal hernias are a common surgical disease of childhood but consist of complicated anatomy which can be difficult to understand for trainees. Especially with the advent of laparoscopic repairs, accurate simulations would be beneficial in reducing the steep learning curve associated with these procedures.

The study group created a low cost 3D model (named the POLISHeR) that could be used to simulate both laparoscopic and open inguinal hernia repairs, and tested it on six experienced surgeons and trainees. 88% of participants felt that this device should be a part of the surgical training curriculum. All participants felt that the steps to perform an inguinal hernia repair on the POLISHeR were of adequate difficulty and realism.

A Randomized Controlled Trial of Perioperative Education via e-health Technology to Ensure High Quality Equitable Care: One-4-ALL Initiative. [3]Acker SN et al., J Pediatr Surg. 2025 Apr;60(4):162235. Epub 2025 Feb 7. PMID: 39954320.

Perioperative education, especially for procedures which require a lot of parental involvement in postoperative care, leaves much to be desired. One potential to improve this is to leverage electronic health education. The study team created the One-4-ALL initiative which aims to transform existing models of perioperative education into an interactive web-based platform.

This study was a randomized trial comparing e-health education to standard education among families with children undergoing gastrostomy placement at a single institution. 87% of families enrolled in e-health created an account and viewed the content. There were no significant differences in comfort or readiness for the procedure between groups, demonstrating that e-health platforms can be a feasible alternative to standard peri-operative education without negative effects on outcomes.

A Biologically Transparent Illumination Device is More Useful in Children for Detecting the Position of the Nasogastric Tube in the Stomach [4] Satake R et al., Pediatr Surg Int. 2024 Oct 26;40(1):275. PMID: 39460791.

Nasogastric (NG) tubes are commonly used in pediatrics for enteral access. While placement is generally low risk, confirmation usually requires an abdominal radiograph that is associated with a delay in timing, radiation exposure, and costs. The use of biologically transparent illumination (BTI) via a light-emitting diode (LED) placed through an NG tube to assist with placement has been reported in the adult population, but not in pediatrics.

This is a prospective study performed in 106 pediatric patients from age 0-16, in which NG insertion was performed with a BTI catheter, and then confirmed with abdominal radiograph. Out of 106 patients, only 1 could not have the BTI visualized in the epigastric region at the time of placement. All 106 NG tubes were confirmed to be properly placed in the stomach by radiograph.

A Pilot Study for Biliary Atresia Diagnosis: Fluorescent Imaging of Indocyanine Green in Stool [5] Lim YZ et al., J Pediatr Surg. 2024 Jul;59(7):1362-1368. Epub 2024 Mar 20. PMID: 38614948

The evaluation of biliary atresia (BA) in infants is challenging, and often necessitates a multitude of studies including eventual surgery with cholangiography. The introduction of near-infrared imaging with indocyanine green (ICG) has seen growing use in pediatric surgery, but it is unknown if its use and presence in stool could be used to affirm biliary patency and exclude the diagnosis of BA in jaundiced infants.

This prospective study of infants (under 12 months) evaluated the timing and presence of ICG in stool in three patient cohorts: a pyloric stenosis control group, jaundiced infants without BA, and jaundiced infants with BA. Both the pyloric stenosis group and the non-BA jaundiced group had diapers positive for stool fluorescence within 24 hours of injection. Out of the 7 infants with BA, 6 did not have stool fluorescence within 24 hours. The authors conclude that ICG detection in stool is 97% accurate for assessing biliary patency.

Let it Glow: Intraoperative Visualization of Pulmonary Metastases using Pafolacianine, a Next-Generation Fluorescent Agent, for Young Adults Undergoing Pulmonary Metastasectomy [6] Lehane A et al., Pediatr Blood Cancer. 2024 Nov;71(11):e31293. Epub 2024 Aug 27. PMID: 39192706.

Pulmonary metastasectomy is a mainstay of treatment in children with sarcoma and lung metastases, but identifying these lesions intraoperatively is difficult. Many surgeons prefer thoracotomy over more minimally invasive approaches in order to use palpation to identify these lesions. The use of fluorescence-guided surgery (FGS) has revolutionized certain procedures, mainly through the use of indocyanine green (ICG), however recent work has identified additional molecular agents which can target certain tumor-specific receptors which can be used to enhance FGS. One of these agents, pafolacianine, targets the folate receptor which is frequently expressed in pulmonary metastases including osteosarcoma.

The authors performed a proof-of-concept study in four children with pulmonary metastases from osteosarcoma and one with Ewing’s sarcoma. Surgery was performed 3-8 hours after the injection of pafolacianine using both thoracoscopic and open techniques. Fluorescence positively identified the osteosarcoma lesions including one lesion which was not seen under standard white light. There was a 4 mm nodule in the child with Ewing sarcoma which did not fluoresce until it had been resected.

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