IPEG 2019 Highlights: From Virtual Reality and Magnets to Robots at the Bedside

Virtual reality headsets have been used to completely eliminate the need for IV or sedating medications in 19 patients during minor surgical procedures over about a year.

All enrolled patients using VR have recommended it for future use, both if they were going to have the surgery again and if other kids were going to have it.

VR has been used primarily for minor procedures requiring just a little bit of sedation medication, specifically hormone implant exchanges and cystostomy tube exchanges.

Imaging combined with robotics can improve the insertion of needles into specific places, whether vessels, lesions, or other targets.

The addition of robotics provides precision and accuracy that allows people who don't necessarily have the experience or training to do advanced vascular access to perform it in settings like the ICU, emergency department, or operating room.

The robotic vascular access device is designed as an assistant device at the bedside to help clinicians be better clinicians, positioned between telemanipulators like Da Vinci and fully autonomous industrial robots.

In a retrospective study of 13 patients across six institutions with long gap esophageal atresia treated with catheter-based magnet devices, all patients achieved anastomosis in an average of 6.3 days.

All patients treated with magnetic compression anastomosis for esophageal atresia had stenosis afterwards requiring dilation.

Six of 13 patients treated with magnetic compression anastomosis required stent placements and two underwent surgery.

92% of patients treated with magnetic compression anastomosis for esophageal atresia had full feeds at time of follow up, which was about 9.3 years.

The magnetic compression anastomosis study was retrospective over 17 years, and a prospective FDA-approved observational study using the Flourish device is underway aiming to enroll 20 patients over two years.

Pyeloplasty has evolved to become the gold standard for taking care of UPJO obstruction.

Bariatric surgery in children and adolescents can be performed at any age as long as there are comorbidities and it is proven safe and effective.

Obese children and adolescents with type 2 diabetes should go for bariatric surgery because it cured diabetes and the cure lasts for up to 10 years in studies.

Bariatric surgery does not affect growth in children and adolescents; in fact, it improved growth by almost 10cm in height in those who are from five to nine years of age.

When children and adolescents lose weight through bariatric surgery at an early age, they can maintain their weight loss for almost up to 10 years.

There are reported cases where surgeons gained access directly through the umbilicus in newborns and babies four to six weeks of age, and patients got air embolus because of unrecognized injury to the umbilical vein.

Direct access through the center of the umbilicus should not be performed in anyone under six to eight weeks of age due to risk of umbilical vein patency and injury, regardless of technique used.

The only safe way to gain abdominal access in infants under 6-8 weeks is through an infraumbilical ring incision, below the vein and between the umbilical arteries.

The risk of umbilical vein injury exists whether using blunt dissection, inserting a trocar, putting a trocar in, or putting a scope in to look.

Most people do not realize that air embolus from umbilical vein injury is a potential complication of direct umbilical access in young infants.

The best advice for getting started writing a manuscript is to either create an outline or write the abstract first, then lock yourself in your office and dictate something that can be edited multiple times.

Authors often don't read the instructions to authors, and there are subtle differences from one journal to another that affect what is expected for publication.

The biggest mistake in manuscript submissions is in the references, because electronic reference manager software is often not in the same format that the Journal of Pediatric Surgery uses.

Authors should ensure the paper has good English grammar and syntax and that the data is the same in the abstract and the paper.