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Pediatrics

By Allen Ferguson,2014-09-22 23:55
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indian pediatrics

Use of Starion Technology in Pediatrics

    Pediatric surgeons have been especially receptive to the Starion technology. By focusing heat between the jaws of the instrument, Starion devices minimize the risk of collateral damage to surrounding tissue and organs. When working in smaller cavities, the reduction of lateral thermal spread offered by the Starion technology becomes even more important.

How Starion can be used in Pediatrics

    Primary Laparoscopic Endorectal Pullthrough for Hirschprung’s Disease

    Colon pullthrough in the treatment of Hirschprung’s Disease in infants and children has evolved from the classic approach requiring multiple procedures to the laparoscopically assisted approach requiring a single procedure. The classic multi-stage surgical approach starts with an initial diverting colostomy, followed months later by a colon pullthrough surgery and completed by a subsequent colostomy. The next stage in the evolution of the procedure was the development of a single primary colon pullthrough using open surgical techniques. This single stage surgical repair offers many advantages over the classic approach, including reduced morbidity, reduced hospital stay and elimination of the need for colostomy. The laparoscopic approach extends the benefits of the single stage surgical approach by providing further reductions in morbidity and hospital stay.

Method

    1. The colon is mobilized, starting with opening a mesenteric window at the rectosigmoid

    junction.

    2. Division of the mesentery is performed using the Starion Instruments TLS 23C.

    3. The blood supply of the proximal colon pedicle is preserved by sparing the marginal

    artery in the mesentery of the colon.

    4. Sometimes ligation of the inferior mesenteric artery close to the takeoff from the aorta is

    required.

    5. Using the TLS 23C helps avoid injury to the left ureter during the dissection of the

    mesocolon.

    6. The lateral fusion fascia and portions of the gastrocolic ligament are divided using the

    TLS 23C to adequately mobilize the colon in some patients.

    7. After the colon pedicle is evaluated for adequate length, dissection of the pelvis is

    initiated at the rectosigmoid junction.

    8. The superior rectal vessels are divided.

    9. Using the TLS 23C allows the distal dissection plane into the pelvis to be performed as

    close to the rectum as possible.

    10. The middle rectal vessels are divided.

    11. With the completion of the rectal dissection, the transanal-perineal dissection is initiated.

    12. During the transanal-perineal dissection, it may be necessary to mobilize more colon.

    This is accomplished by transanally dividing the short mesenteric branches of the

    marginal artery and vein.

    13. An anastomsosis is completed between the distal rectal mucosal cuff and ganglionated

    colon.

Benefits of Starion Technology

    Use of the TLS 23C enable surgeons to accomplish the mobilization of the colon with minimal risk of injury to the organ and adjacent sensitive structures like the ureter. The precise application of thermal energy to target tissues while limiting collateral thermal spread allows precise dissection in close proximity to sensitive organs. In addition the multifunctional TLS 23C reduces instrument exchanges during the procedure.

How Starion can be used in Pediatrics

    Laparoscopic Appendectomy

    Minimally invasive laparoscopic appendectomy in children has been demonstrated to reduce morbidity and facilitate an earlier return to normal activities in children Method

    1. The peritoneal cavity is insufflated and three 5mm laparoscopic access ports are placed

    using conventional techniques.

    2. The tip of the appendix is grasped and a window is established in the meso-appendix

    using the tip of the Starion Instruments Corporation TLS 23C at the junction of the

    appendix and cecum.

    3. The meso-appendix is transected using the TLS 23C

    4. Following transection of the meso-appendix, the base of the appendix is ligated using

    endo-loops.

    5. The appendix is transected, placed in an endo-bag and removed through the lower left

    quadrant trocar.

    Benefits of Starion Technology

    Use of Starion technology reduces risk of injury to adjacent structures (i.e. bowel), eliminates the need for using a 12mm trocar and reduces procedure cost by eliminating the need for a linear stapler.

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