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Laparoscopy in pediatric surgery: Implementation in Canada and supporting evidence
Victoria Sattarova1, Simon Eaton2, Nigel J Hall3
1Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Journal of Pediatric Surgery
|March 6, 2016
Summary
Laparoscopic surgery adoption in Canadian pediatric centers varied, with some procedures plateauing while others, like pyloromyotomy, continue to grow despite strong evidence. This highlights challenges in implementing evidence-based pediatric laparoscopic surgery.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Health Services Research
Background:
- Laparoscopic surgery offers benefits in pediatric care.
- Assessing the adoption rates and evidence base for pediatric laparoscopic procedures is crucial.
Purpose of the Study:
- To evaluate the diffusion of laparoscopy in Canadian pediatric surgery centers.
- To examine the correlation between laparoscopic surgery uptake and supporting evidence levels.
Main Methods:
- Analysis of national data for four pediatric laparoscopic operations (2002-2013).
- Identification of highest evidence levels from Cochrane, Embase, and PubMed.
- Statistical analysis using chi-square test for trend and time to plateau.
Main Results:
- Laparoscopic procedure use increased significantly over time (p<0.0001).
- Plateaus were observed for cholecystectomy, splenectomy, and appendectomy.
- Laparoscopic pyloromyotomy showed continued growth but remained less utilized despite level-1a evidence in children.
Conclusions:
- High-level implementation of pediatric laparoscopic surgery in Canada has been slow.
- Evidence-level disparities exist for adult vs. pediatric laparoscopic procedures.
- Laparoscopic pyloromyotomy's low diffusion despite strong evidence warrants further investigation.
