Skip to main content
SpringerLink
Log in

Evaluating the impact of a minimally invasive pediatric surgeon on hospital practice: comparison of two children’s hospitals

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Purpose

Widespread adoption of minimally invasive surgery (MIS) techniques in pediatric surgery has progressed slowly, and the shift in practice patterns has been variable among surgeons. We hypothesized that a pediatric surgeon committed to MIS could effectively change surgical practice by creating an emphasis on MIS.

Methods

Annual case volumes from 2000 to 2009 at two tertiary care pediatric hospitals, one with a dedicated minimally invasive pediatric surgeon, were evaluated for trends in MIS for ten different operations. Univariate analyses of the differences between hospitals in the use of the open versus laparoscopic approach were performed. The Breslow–Day test was used to examine differences in use of laparoscopic procedures across hospitals in early versus middle and middle versus late time periods.

Results

Between the two hospitals, for 9 of the 10 types of surgery, the number of laparoscopic and open procedures differed significantly (p values ranged from <0.0001 to 0.003). Over the 10-year period, the hospital with a dedicated MIS surgeon had a larger proportion of procedures done laparoscopically for all years. This difference reached statistical significance for appendectomy (p < 0.0001), congenital diaphragmatic hernia (p < 0.0002), chest wall reconstruction (p < 0.0001), cholecystectomy (p = <0.0001), gastrostomy (p < 0.0001), nissen fundoplication (p < 0.0001) oophorectomy (p < 0.0001), pyloromyotomy (p < 0.0001) and splenectomy (p = 0.0006). After grouping the years into early (2000–2003), middle (2004–2006) and late (2007–2009) categories, the hospital with a dedicated MIS surgeon had a significantly higher rate of increase in use of laparoscopic surgery between the early and middle years for four procedures: diaphragmatic hernia repair (p = 0.003), chest wall reconstruction (p = 0.0086), cholecystectomy (0.0083) and endorectal pull-through (p = 0.025).

Conclusion

The presence of a dedicated minimally invasive pediatric surgeon led to a significant change in surgical practice with an overall trend of increasing MIS several years in advance of a hospital that did not have a dedicated MIS surgeon. This has implications for resident training in academic medical centers and potential patient care outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Georgeson KE, Robertson DJ (2004) Minimally invasive surgery in the neonate: review of current evidence. Semin Perinatol 28(3):212–220

    Article  PubMed  Google Scholar 

  2. Dubois F, Berthelot G, Levard H (1989) Cholecystectomy by coelioscopy. Presse Med 18(19):980–982

    CAS  PubMed  Google Scholar 

  3. Birch DW, Misra M, Farrokhyar F (2007) The feasibility of introducing advanced minimally invasive surgery into surgical practice. Can J Surg 50(4):256–260

    PubMed  PubMed Central  Google Scholar 

  4. Chiasson PM, Pace DE, Schlachta CM, Mamazza J, Poulin EC (2004) Minimally invasive surgical practice: a survey of general surgeons in Ontario. Can J Surg 47(1):15–19

    PubMed  PubMed Central  Google Scholar 

  5. Dominguez EP, Barrat C, Shaffer L, Gruner R, Whisler D, Taylor P (2013) Minimally invasive surgery adoption into an established surgical practice: impact of a fellowship-trained colleague. Surg Endosc 27(4):1267–1272

    Article  PubMed  Google Scholar 

  6. Bal S, Elshershari H, Celiker R, Celiker A (2003) Thoracic sequels after thoracotomies in children with congenital cardiac disease. Cardiol Young 13(3):264–267

    PubMed  Google Scholar 

  7. Bianchi A, Sowande O, Alizai NK, Rampersad B (1998) Aesthetics and lateral thoracotomy in the neonate. J Pediatr Surg 33(12):1798–1800

    Article  CAS  PubMed  Google Scholar 

  8. Cherup LL, Siewers RD, Futrell JW (1986) Breast and pectoral muscle maldevelopment after anterolateral and posterolateral thoracotomies in children. Ann Thorac Surg 41(5):492–497

    Article  CAS  PubMed  Google Scholar 

  9. Ferreira CG, Reinberg O, Becmeur F et al (2009) Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy. Surg Endosc 23(7):1650–1659

    Article  Google Scholar 

  10. Kalfa N, Allal H, Raux O et al (2007) Multicentric assessment of the safety of neonatal videosurgery. Surg Endosc 21(2):303–308

    Article  PubMed  Google Scholar 

  11. McKinnon LJ, Kosloske AM (1990) Prediction and prevention of anastomotic complications of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 25(7):778–781

    Article  CAS  PubMed  Google Scholar 

  12. Rothenberg SS (2013) Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates, first decade’s experience. Dis Esophagus 26(4):359–364

    Article  CAS  PubMed  Google Scholar 

  13. Acker SN, Staulcup S, Partrick DA, Somme S (2014) Evolution of minimally invasive techniques within an academic surgical practice at a single institution. J Laparoendosc Adv Surg Tech A 24(11):806–810

    Article  PubMed  Google Scholar 

Download references

Disclosures

Hope T. Jackson, Sohail R. Shah, Emily Hathaway, Evan P. Nadler, Richard L. Amdur, Shannon McGue and Timothy D. Kane declare that they have no competing interests or financial ties to disclose with regard to this work.

Author information

Authors and Affiliations

  1. Department of Surgery, George Washington University School of Medicine, Washington, DC, USA

    Hope T. Jackson, Richard L. Amdur & Timothy D. Kane

  2. Department of Surgery, Children’s Mercy Hospital, Kansas City, MO, USA

    Sohail R. Shah

  3. Department of Surgery, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010-2970, USA

    Emily Hathaway, Evan P. Nadler, Shannon McGue & Timothy D. Kane

Authors
  1. Hope T. Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sohail R. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily Hathaway
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Evan P. Nadler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard L. Amdur
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shannon McGue
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Timothy D. Kane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy D. Kane.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jackson, H.T., Shah, S.R., Hathaway, E. et al. Evaluating the impact of a minimally invasive pediatric surgeon on hospital practice: comparison of two children’s hospitals. Surg Endosc 30, 2281–2287 (2016). https://doi.org/10.1007/s00464-015-4227-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4227-5

Keywords

Search

Navigation