In Situ Surgery: Is It Safe ? (Experience with 60 cases)
Keywords: In-Situ Surgery (ISS) – Neonatal Surgical Unit (NSU).
AbstractBackground/Purpose: Neonatal surgical unit (NSU) is the area of a hospital where sick babies having surgical problem go once they are born. Performing in-situ surgery (ISS) in the NSU is relatively a new concept that is gaining popularity in the last decade. Critically ill neonates who are too ill to transfer to the operating room can undergo safe surgery in the NSU environment of a fully-equipped pediatric hospital. Transfer of the critically ill neonates is time consuming, utilizing manpower and requiring suitable portable ventilators and extensive monitoring equipments. Materials & Methods: This is a prospective study conducted on 60 neonates admitted in the surgical neonatal unit of the Cairo University pediatric hospital (Abou-Elrish) and where subjected to surgical procedures in the unit itself. The patients were categorized into 3 groups: The First group was the group at the beginning of the study for which minor procedures were selected. The second group was those neonates that were operated upon on emergency base for which transfer could be hazardous. The last group included those patients on high settings of ventilation and critically ill neonates with extensive monitoring. Results: There was no mortality in the study related to the procedures itself. Group I patients: the time of the surgical procedures was longer than that in the OR and no increase in the infection rate was noticed. Group II in which emergency procedures were carried on showed also increase in operating time but better perioperative circumstances regarding secondary insult to viable structures & less infection rate. Group III: no significant change in outcome in comparison to cases transferred to OR except that the perioperative circumstances were better for the surgeon, anesthesiiologist & nursing teams. Conclusion: NSU is a safe place for performing in-situ surgery (ISS) without increased risk of infection. Successful operative intervention within NSU requires good planning and cooperation between anesthesiologist, surgeons, neonatologist and nursing staff. Maximum benefit is observed in neonates who have definite risk attached to transfer to operating room. Index Word: In-Situ Surgery (ISS) – Neonatal Surgical Unit (NSU).
The journal is the official journal of the: Egyptian Pediatric Surgical Association(EPSA) Mediterranean Association of Pediatric Surgeons (MAPS)\ Pan African Pediatric Surgical Association (PAPSA) Pan Arab Association of Pediatric Surgeons (PAAPS