Minimally Invasive Pediatric Surgery During Remote Humanitarian Missions Is Feasible, Safe, and Effective

There remains a critical need for the provision for pediatric humanitarian aid worldwide. Historically, the emphasis of global pediatric health needs has been focused on infectious diseases. Today, we are witnessing a shift in this paradigm, with growing attention being paid toward the surgical needs of children. The use and deployment of minimally invasive surgery (MIS) in these austere environments with its concomitant reduction in length of hospitalization, pain, and morbidity is logical. The goal of this study was to report our deployment strategy and review our experience with pediatric MIS during humanitarian missions to determine if it is safe, feasible, and efficacious.

As part of the World Pediatric Project (WPP), data were collected retrospectively from the general pediatric surgery (GPS) team missions from January 2007 to January 2017. All cases were performed at a single medical center in the Eastern Caribbean Island Nation of St. Vincent and the Grenadines (SVG). Data included patient demographics, diagnosis, procedure, conversion to open procedure, complications, and postoperative course. The teams utilized a dedicated WPP operating theater, prepositioned and deployed GPS supplies, and MIS resources. All anesthesia, surgical, and nursing personal were board certified and trained professionals functioning as part of the WPP team.

One hundred thirty-four children underwent general and thoracic pediatric surgical procedures during the study period. Mean age 9.2 years (2-19 years). Thirty-seven children underwent MIS procedures (27%). There were no conversions to open procedures. There were only two postoperative complications, cellulitis following laparoscopic appendicostomies, which required intravenous antibiotics and were discharged on a course of oral antibiotics. The postoperative course for all children was uneventful and no child required readmission. There were no technical failures in the MIS systems or instrumentation.

Our retrospective review supports the use of MIS techniques as part of GPS humanitarian missions. We have found it to be a safe, feasible, and effective modality that may reduce length of stay, pain, and morbidity compared with open procedures in these remote environments. Although our MIS systems and instrumentations functioned effectively, concerns regarding the storage and sustainability for future missions are significant. Onsite health care partners, redundant systems, and remote technical support access could potentially alleviate these concerns.