Papers by Scott Langenburg
Annals of Hematology, Sep 17, 2020
Journal of Automation and Information Sciences, 2003
Minimally invasive surgery techniques have revolutionized surgery. Robotic surgery may be the nex... more Minimally invasive surgery techniques have revolutionized surgery. Robotic surgery may be the next revolution in surgical technology. Robotics coupled with minimally invasive surgery and microscopic surgery provides the potential to do more complex and more precise tasks. Robotic surgery offers tremor filtration, motion scaling, indexed movements, additional degrees of freedom, and improved ergonomics. We explore robotic history, the present surgical technology, the current clinical cases and research, and the future of robotics. We will look specifically at the birth and progress of our own problem.
Journal of Pediatric Surgery, Sep 1, 2004
Repair of esophageal atresia and tracheoesophageal fistula (TEF) in the newborn is challenging wh... more Repair of esophageal atresia and tracheoesophageal fistula (TEF) in the newborn is challenging when done as an open procedure but only a few surgeons have attempted this with minimally invasive surgery (MIS). Surgical robots that hold MIS instruments have wrists and provide tremor filtration and motion scaling, which might be expected to facilitate complex procedures in small spaces such as an esophageal anastomosis in a newborn. Methods: Seven newborn pigs weighing 2 to 3 kg were used as a model. The authors performed an esophageal resection and end-to-end anastomosis using the Zeus Microwrist Robotic Surgical System. The authors monitored the following data-Zeus robotic setup time, operating time, esophageal dissection time, and anastomosis time. After 1 month, the animals were anesthetized to perform esophagram and than were killed. Results: In these very small animals the space available for performing an anastomosis is very limited, approximately 2 cm 3. Two pigs each died 18 days postoperatively. One animal could not eat and died during esophageal dilation. The second pig died of unrelated enteritis. Neither had evidence of anastomotic leak at autopsy. The esophagram of the 5 pigs that survived for 30 days showed no narrowing or proximal dilation in 2. In 3 there was some stenosis requiring dilation. Histopathology was done on each operated animal. Two of the anastomoses were well healed, and 5 showed only focal small ulceration. Conclusions: Robotic assistance facilitates an MIS approach to the upper esophagus even in the limited space of the infant chest.
Journal of pediatric surgery case reports, Feb 1, 2019
We report the case of a 3-year-old male who presented in cardiac arrest with a self-inflicted gun... more We report the case of a 3-year-old male who presented in cardiac arrest with a self-inflicted gunshot wound (GSW) to the abdomen. Upon arrival by private vehicle to our hospital, an emergency department thoracotomy (EDT) was performed in addition to standard resuscitative efforts. Despite prolonged initial hypotension, multiple episodes of cardiac arrest, and several postsurgical complications, the patient was eventually discharged from the hospital with no residual neurological deficits.
Journal of pediatric surgery case reports, Feb 1, 2019
We present the case of a 12 year-old female with spastic quadriplegia whose gastrostomy tube butt... more We present the case of a 12 year-old female with spastic quadriplegia whose gastrostomy tube button was inadvertently displaced resulting in the intraperitoneal administration of formula with subsequent severe peritonitis, septic shock and death within 48 h. The operating room findings included 700 cc of formula in the peritoneal cavity and the partial separation of the gastric wall at the gastrostomy site from the abdominal wall. The patient had undergone spinal corrective surgery 5 months prior and her gastrostomy tube has been replaced per routine by the caregiver the day prior to the onset of symptoms. We hypothesize that the postsurgical positional changes resulting from her spinal corrective surgery changed her stomach relationship to the abdominal wall placing the gastrostomy button on tension and resulting in the erosion of the balloon through the stomach wall with disruption of the gastrostomy tract. We recommend that meticulous monitoring, changing button to a regular gastrostomy tube and potential repositioning of the gastrostomy tube site be considered after spinal corrective surgery in such patients.
Seminars in Pediatric Surgery, Feb 1, 2008
Thoracoscopy of pediatric patients has evolved from diagnostic lung biopsy to a myriad of both di... more Thoracoscopy of pediatric patients has evolved from diagnostic lung biopsy to a myriad of both diagnostic and therapeutic procedures. In this chapter, we discuss those procedures related to the child's lung which are most commonly performed: lung biopsy; resection of bronchogenic cysts, pulmonary sequestrations, and pulmonary lobes; and the treatment of spontaneous pneumothorax.
Journal of Pediatric Surgery, Jun 1, 2010
We present a case of neonatal ovarian torsion complicated by bowel obstruction and perforation an... more We present a case of neonatal ovarian torsion complicated by bowel obstruction and perforation and review the literature regarding the incidence of bowel obstruction in neonatal ovarian cysts, the presentation, and treatment. A term neonate was prenatally diagnosed with a cystic abdominal mass palpable on physical examination. A postnatal abdominal x-ray showed paucity of gas in the left hemiabdomen with rightward displacement of bowel loops. Exploratory laparotomy on day 2 of life revealed a large cystic mass in the left lower quadrant consistent with a torsed left ovary, an omental band causing strangulation of the bowel mesentery, and a perforation of the distal ileum. Our literature search revealed 19 reported cases of neonatal ovarian cysts resulting in bowel obstruction. Infants may present with a palpable abdominal mass, respiratory distress, as well as signs and symptoms of intestinal obstruction. Two mechanisms exist for bowel obstruction: adhesions caused by a torsed necrotic ovary and mass effect of a large ovarian cyst, often measuring 9 to 10 cm in diameter. Options to treat ovarian cysts include antenatal or postnatal aspiration, laparoscopy, and laparotomy. Cysts less than 4 to 5 cm can be observed, whereas operative intervention is indicated in symptomatic cases and in persistent or enlarging ovarian cysts.
Journal of Pediatric Surgery, Jun 1, 2000
Background/Purpose: Presence of large bile ducts (Ͼ200 µm) at the portal end-plate has been sugge... more Background/Purpose: Presence of large bile ducts (Ͼ200 µm) at the portal end-plate has been suggested to predict success after portoenterostomy. The authors reviewed their patients with biliary atresia to test the hypothesis that bile duct size in patients with successful portoenterostomy was no different than in the patients with unsuccessful portoenterostomy. Methods: The authors reviewed the patients at their institution from 1989 to 1998 who had the diagnosis of biliary atresia (n ϭ 38). A pathologist blinded to the results of the operation confirmed the measurements of the bile duct remnants. Results: Five of the 38 patients did not have a portoenterostomy. They underwent cholangiogram and liver biopsy and were evaluated for liver transplantation. All patients who underwent surgery (n ϭ 33) had a Roux-en-y hepaticojejunos-tomy. Twenty-one patients had successful surgery (64%) and 12 patients (36%) had unsuccessful surgery. The average age at operation in the successful group was 50.9 Ϯ 3 days and in failures, 57.9 Ϯ 4 days (P ϭ .16). Duct size at the portal end-plate was not different between the successes and failures. Two of the patients in the success group had no evidence of bile ducts grossly or histologically. Conclusion: Children presenting early in infancy (Ͻ3 months) with biliary atresia should undergo a portoenterostomy regardless of the size of the bile ducts at the time of exploration.
Journal of Pediatric Surgery, Apr 1, 1993
Journal of pediatric surgery case reports, Dec 1, 2016
Mesenteric adenitis is an inflammation and enlargement of the mesenteric lymph nodes often second... more Mesenteric adenitis is an inflammation and enlargement of the mesenteric lymph nodes often secondary to an infection. Symptoms often mimic many of the common causes of right lower quadrant abdominal pain and it is usually a benign, self-limited disease. We report a case of a 12 year old girl with mesenteric adenitis in which enlarged lymph nodes obstructed blood flow to her ascending colon, causing venous and arterial thrombosis and ischemic colitis, requiring a right hemi-colectomy. Ischemic colitis should be included on the wide differential for right lower quadrant pain and quickly identified to provide the best outcome for the patient.
Surgical Endoscopy and Other Interventional Techniques, May 27, 2004
Background: Major enhancements offered by robotic surgery for minimally invasive procedure includ... more Background: Major enhancements offered by robotic surgery for minimally invasive procedure include tremor filtration, motion scaling, and the addition of a wrist to the instrument. Minor enhancements include indexing as well as safe and rapid instrument exchange. A benefit associated with any endoscopic procedure is magnification. It was hypothesized that these enhancements would allow the performance of complex gastrointestinal surgery. Methods: Eight survival pigs (weight, 2.5-8 kg) underwent a robotically assisted minimally invasive portoenterostomy. The procedure was analogous to the Kasai portoenterostomy for biliary atresia usually performed for human patients at the age of 4 to 12 weeks. Results: Five of the eight animals survived for more than 1 month after the operation, returning to normal eating and bowel habits in 2 to 3 days. None were jaundiced. All laboratory values were normal. At 1 month, the animals were killed. There was no anastomotic stenosis at either the end-to-side enteroenterostomy or the portoenterostomy. Histologically, the anastomoses were well healed. Conclusion: Computer-assisted robot-enhanced technology allows complex gastrointestinal surgery to be performed using minimally invasive techniques.
The journal of trauma and acute care surgery, Jun 1, 2015
Current Opinion in Pediatrics, Jun 1, 2003
Archives of Disease in Childhood-fetal and Neonatal Edition, Aug 29, 2012
... Lawrence Ku,1 Vaneet Kumar Kalra,2 Stephanie Salinas,1 Nitin Chouthai,2 Athina Pappas,2 Scott... more ... Lawrence Ku,1 Vaneet Kumar Kalra,2 Stephanie Salinas,1 Nitin Chouthai,2 Athina Pappas,2 Scott E Langenburg3 1Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA ... REFERENCES 1. Vermeij-Keers Chr, Hartwig NG, van der Werff JFA. ...
Current Surgery Reports, Apr 14, 2015
ABSTRACT
Fetal and Pediatric Pathology, Nov 9, 2020
Background: Fibroepithelial polyps of the anus have been described as mucosal hypertrophy in resp... more Background: Fibroepithelial polyps of the anus have been described as mucosal hypertrophy in response to chronic irritation or tissue damage. Lesions usually remain small and mostly present in elderly adults with local disease. Case Report: An otherwise healthy 15year-old male presented with a giant pedunculated mass projecting out of the anal verge that enlarged over 2 years, causing discomfort. Results: Upon surgical excision and histologic examination, the mass resembled a fibroepithelial polyp with numerous dilated lymphatics. Conclusions: While literature describes the spectrum of pathology possible in such lesions, often consisting of a mixture of stromal and epithelial components, dilated lymphatics are less common. This giant anal fibroepithelial polyp characterized by edematous stroma and numerous dilated lymphatics is consistent with lymphangioma. To our knowledge, this presentation is novel in this age group with no underlying risk factors.
Pediatric Surgery International, Oct 21, 2014
Vaginal bleeding in young girls is a distressing symptom. Due to the potential for malignancy, th... more Vaginal bleeding in young girls is a distressing symptom. Due to the potential for malignancy, thorough investigation is needed. Though rare, Müllerian papillomas are a benign cause of such symptoms. We report the case of a 2-year-old female who presented with acute onset of vaginal bleeding. She had another episode of bleeding during admission and was taken to the operating room for vaginoscopy under general anesthesia. A single friable lesion with active bleeding was visualized near the anterior vagina or cervix, which was biopsied. Histopathologic examination demonstrated characteristic features of benign Müllerian papilloma of infancy. Müllerian papillomas require examination under anesthesia and vaginoscopy with biopsies for efficient and accurate diagnosis. Treatment consists of complete local excision. Local recurrences are not uncommon, though prognosis for primary or recurrent disease is excellent.
The American journal of pediatric hematology/oncology, Nov 1, 2000
Spinal cord compression secondary to metastases is an infrequent complication of childhood cancer... more Spinal cord compression secondary to metastases is an infrequent complication of childhood cancer. We describe an infant with hepatoblastoma in whom cord compression developed because of extensive epidural metastases during treatment. This is a hitherto undescribed metastatic site for hepatoblastoma.
Fetal and Pediatric Pathology, 2020
Background: Fibroepithelial polyps of the anus have been described as mucosal hypertrophy in resp... more Background: Fibroepithelial polyps of the anus have been described as mucosal hypertrophy in response to chronic irritation or tissue damage. Lesions usually remain small and mostly present in elderly adults with local disease. Case Report: An otherwise healthy 15year-old male presented with a giant pedunculated mass projecting out of the anal verge that enlarged over 2 years, causing discomfort. Results: Upon surgical excision and histologic examination, the mass resembled a fibroepithelial polyp with numerous dilated lymphatics. Conclusions: While literature describes the spectrum of pathology possible in such lesions, often consisting of a mixture of stromal and epithelial components, dilated lymphatics are less common. This giant anal fibroepithelial polyp characterized by edematous stroma and numerous dilated lymphatics is consistent with lymphangioma. To our knowledge, this presentation is novel in this age group with no underlying risk factors.
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Papers by Scott Langenburg