Background: Both thoracic drainage and video-assisted thoracic surgery (VATS) are available treatment for pleural empyema in pediatric patients. Materials and methods: This retrospective multicenter study includes pediatric patients affected by pleural empyema treated from 2004 to 2021 at two Italian centers. Patients were divided in G1 (traditional approach) and G2 (VATS). Demographic and recovery data, laboratory tests, imaging, surgical findings, post-operative management and follow-up were analyzed. Results: 70 patients with a mean age of 4.8 years were included; 12 (17.1%) in G1 and 58 (82.9%) in G2. Median surgical time was 45 min in G1, 90 in G2 (p < 0.05). Mean duration of thoracic drainage was 7.3 days in G1, 6.2 in G2 (p > 0.05). Patients became afebrile after a mean of 6.4 days G1, 3.9 in G2 (p < 0.05). Mean duration of antibiotic therapy was 27.8 days in G1, 25 in G2 (p < 0.05). Mean duration of postoperative hospital stay was 16 days in G1, 12.1 in G2 (p < 0.05). There were 4 cases (33.3%) of postoperative complications in G1, 17 (29.3%) in G2 (p > 0.05). 2 (16.7%) patients of G1 needed a redosurgery with VATS, 1 (1.7%) in G2. Conclusions: VATS is an effective and safe procedure in treatment of Pleural Empyema in children: it is associated to reduction of chest tube drainage, duration of fever, hospital stay, time of antibiotic therapy and recurrence rate.

The need for cholecystectomy during pediatric age has significantly increased in the last two decades. As biliary pathology increases, the probability of complicated cholecystectomies increases too. The aim of this article is to analyze our experience with difficult laparoscopic pediatric cholecystectomy, focusing on the importance of an accurate pre-operative imaging study. We retrospectively analyzed all patients affected by cholelithiasis who underwent laparoscopic cholecystectomy at the Pediatric Surgery Department of San Camillo Forlanini hospital of Rome and Santa Maria alle Scotte University Hospital of Siena from 2017 to 2022. Demographic data, body mass index (BMI), recovery data, laboratory tests, imaging exams, surgical findings, post operative management and outcome were taken into account. Overall, 34 pediatric patients, with a mean age of 14.1 years (6–18 years) were included, with a mean BMI of 29. All patients underwent abdominal ultrasonography and a liver MRI with cholangiography (cMRI). We identified five cases as “difficult cholecystectomies”. Two subtotal cholecystectomies were performed. Cholecystectomy in pediatric surgery can be difficult. The surgeon must be able to find alternative strategies to total cholecystectomy to avoid the risk of possible bile duct injury (BDI). Pre-operative imaging study trough ultrasound and especially cMRI is crucial to recognize possible difficulties and to plan the surgery.

Even if vesicoureteral reflux is a common condition in children, there are no guidelines about the best therapeutic approach. This study aims to compare the results of endoscopic injection and ureteral reimplantation in children with grade III, IV and V VUR. A multicenter retrospective study included children with grade III, IV and V VUR treated from 2003 to 2018 at three Departments of Pediatric Surgery. Patients were divided into Group A (endoscopic injections) and Group B (anti-reflux surgery), B1 (open, OUR), B2 (laparoscopic, LUR) and B3 (robot-assisted laparoscopic RALUR). Follow-up was at least 5 years. 400 patients were included, 232 (58%) in group A and 168 (42%) in group B. Mean age at surgery was 38.6 months [3.1–218.7]. Mean follow-up was 177.8 months [60–240]. Group A had shorter operative time than group B (P < 0.01); lower analgesic requirement (p < 0.05), shorter hospital stay (P < 0.05) and lower overall costs (p < 0.05), but higher postoperative PNPs (p < 0.01), lower success rate (p < 0.01) and higher redo-surgery percentage (p < 0.01). No differences in terms of postoperative complications, success rate and mean radiation exposure between the two groups. Endoscopy is associated with shorter operative time, shorter hospitalization and lower cost, also in case of multiple injections. Recurrence rate after surgery is lower meaning lower rate of re-hospitalization and radiation exposure for children.

Background: Robot‐assisted approach to UVJ is getting more and more used in pediatric patients.Methods: In this retrospective study 26 patients affected by nephro‐urological malformations, robotic‐surgically treated from 2016 and 2021 at 3 Pediatric Surgery Department were included: 3 (11.5%) primary obstructive megaureter, 2 (7.7%) dysplastic kidneys, 3 (11.5%) duplex collecting system, 18 (69.2%) primary vescico‐ureteral reflux (VUR).Results: Mean age at surgery was 6 years old. 22 (84.6%) underwent Lich Gregoire extravesical ureteral reimplantation, 4 (15.4%) total nephroureterectomy. Mean operative time was 230 min. No conversions or intraoperative complications. Median hospital stay was 4 days. There were 4 (15.38%) postoperative complications: 3 (11.54%) persistent VUR and 1 (3.84%) refluxing megaureter. 2 (7.7%) redo‐surgery.Conclusions: Robotic Surgery should be considered a safe and effective technique for treatment of UVJ anomalies in children, because it firstly allows surgeons to approach both upper and lower ureteral ends without modifying trocars’ placement.

Background: Minimally invasive surgery (MIS) for adrenal pathologies in children is still developing because of its low incidence in pediatric population and the discrepancy between the big volume of the masses and the reduced child's size especially in younger patients. In the literature, there are no guidelines about the use of laparoscopic andrenalectomy in children. The aim of this study is to evaluate the outcomes of MIS through a bicenter data analysis in order to propose a standardized protocol. Materials and Methods: Children who underwent minimally invasive adrenalectomy performed at two European Departments of Pediatric Surgery between 2000 and 2020 were included in this study. Data were collected and analyzed using X-square, Fisher tests, and multiple regression model. Results: Thirty-four patients (38 adrenal masses) were included. Mean age was 52 months (3-176). Median lesion diameter was 60 mm (40-125 mm). Histological examination revealed 24 neuroblastomas (NBs), 11 pheochromocytomas, 1 teratoma, 1 adrenal cyst, and 1 myelolipoma. Laterality was 52.6% left, 36.8% right, and 10.5% bilateral. Surgical access was transperitoneal in all patients. Mean operative time was 108 minutes for unilateral lesions and 270 minutes for bilateral ones. Mean hospital stay was 4.4 days. No major intraoperative complications were observed. 21.05% NBs were preemtively approached with a laparoscopic access and were converted to open surgery. Median follow-up was 88 months (24-264). Four patients affected by neuroblastoma reported metastatic dissemination and three died. Conclusions: Pediatric minimally invasive adrenalectomy is a safe and effective procedure, allowing surgeons to reduce the size of incision starting the dissection of the masses, and it has low rate of complication if we consider small masses. The only absolute contraindication is persistent image-defined risk factors for NBs. It should be considered as the first-line treatment for selected adrenal masses in centers with good experience in laparoscopy.