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Article

Pediatric Minimally Invasive Surgery—A Bibliometric Study on 30 Years of Research Activity

Department of Pediatric Surgery, University of Leipzig, 04103 Leipzig, Germany
*
Author to whom correspondence should be addressed.
Children 2022, 9(8), 1264; https://doi.org/10.3390/children9081264
Submission received: 27 July 2022 / Revised: 15 August 2022 / Accepted: 16 August 2022 / Published: 21 August 2022
(This article belongs to the Special Issue Progress in Neonatal Surgical Diseases and Minimal Invasive Treatment)

Abstract

:
Background: Pediatric minimally invasive surgery (MIS) is a standard technique worldwide. We aimed to analyze the research activity in this field. Methods: Articles on pediatric MIS (1991–2020) were analyzed from the Web of Science™ for the total number of publications, citations, journals, and impact factors (IF). Of these, the 50 most cited publications were evaluated in detail and classified according to the level of evidence (i.e., study design) and topic (i.e., surgical procedure). Results: In total, 4464 publications and 53,111 citations from 684 journals on pediatric MIS were identified. The 50 most cited papers were published from 32 institutions in the USA/Canada (n = 28), Europe (n = 19), and Asia (n = 3) in 12 journals. Four authors (USA/Europe) contributed to 26% of the 50 most cited papers as first/senior author. Hot topics were laparoscopic pyeloplasty (n = 9), inguinal hernia repair (n = 7), appendectomy, and pyloromyotomy (n = 4 each). The majority of publications were retrospective studies (n = 33) and case reports (n = 6) (IF 5.2 ± 3.2; impact index 16.5 ± 6.4; citations 125 ± 39.4). They were cited as often as articles with high evidence levels (meta-analyses, n = 2; randomized controlled trials, n = 7; prospective studies, n = 2) (IF 12.9 ± 22.5; impact index 14.0 ± 6.5; citations 125 ± 34.7; p > 0.05). Conclusions: Publications on laparoscopic pyeloplasty, inguinal hernia repair, appendectomy, and pyloromyotomy are cited most often in pediatric MIS. However, the relevant number of studies with strong evidence for the advantages of MIS in pediatric surgery is missing.

1. Introduction

The first pediatric laparoscopic operation was published by Jean-Luc Alain from France in 1991, describing a pyloromyotomy in hypertrophic pyloric stenosis using 3 mm trocars [1,2,3,4]. In the same year, laparoscopic cholecystectomy and ovarian detorsion were reported by George W. Holcomb and Eliezer Shalev [5,6]. The first pediatric thoracoscopic procedure, namely the evacuation of empyema in nine children, was published 2 years later by John A. Kern [7]. In 1999, Thom E. Lobe reported the first thoracoscopic repair of esophageal atresia (Type A) in an 8-month-old infant weighing 3.4 kg [8]. Finally, Klaus Heller described the first robotic fundoplication in 2002 [9].
Since then, minimally invasive surgery (MIS) has been widely accepted for better cosmesis, shorter recovery, less trauma, and better visualization, which are particularly important for infants and adolescents [10,11]. Its success has been documented in numerous case reports, clinical trials, and meta-analyses [12,13,14]. However, until today the research activity on pediatric MIS has not been studied in detail. Bibliometrics estimates the impact of scientific work using mathematical and statistical tools [15]. Research activity can be assessed by publication (quantity) and citation numbers (quality) [16]. Moreover, bibliometric studies can assess individual research interests and enable the identification of potential research collaborations [17].
Here, we aim to analyze the research activity as well as the 50 most cited papers on MIS for their topics as well as evidence levels over the last 30 years. We hypothesized that the trend of research activity as well as the evidence levels of publications on pediatric MIS has been increasing over time.

2. Materials and Methods

Original, peer-reviewed scientific publications published on pediatric MIS between 1991 and 2020 were identified using the Web of Science Core Collection™ (www.webofknowledge.com, Clarivate Analytics, Boston, MA, USA) by two independent reviewers (BS, XF) on 1 March 2021 according to the search items listed in Table 1. These inclusion and exclusion items were defined by the research group to allow the identification of as many and specific publications on pediatric MIS as possible. Additionally, to analyze only relevant search results, a “title” instead of “topic” search approach was used [16].
All identified articles reporting on minimally invasive interventions in children identified by this search were screened for the study. Papers reporting on diagnostic interventions only, e.g., diagnostic laparoscopy or endoscopy, or from other surgical fields such as neurosurgery or cardiac surgery were excluded from our dataset. There were no restrictions on the type of article or language.
Data on publications extracted from the Web of ScienceTM software included: publication year, country/continent, institution, author, and journal. Number of publications defined the particular research quantity. Research quality was defined as the total number of citations and impact index as well as impact factor of the corresponding journal. The impact factor was extracted from the Journal Citation Reports (Clarivate Analytics) for 2020. The impact index was calculated by dividing the number of years since publication by the number of citations and then multiplied by 100. The lower the impact index, the higher the citation rate since publication, thus indicating an augmented recognition [16].
To identify hot topics of pediatric MIS research, the 50 most cited papers were examined in detail. At first, the top 10 institutions, first/senior authors, and journals defined by the number of publications were recorded. Second, papers were screened manually by two independent authors (BS, XF) for the disease and/or operative procedure such as thoracoscopy, laparoscopy, thoracic operations, gastrointestinal or urological surgery. Evidence levels were classified according to Cashin et al. from high to low: meta-analyses (Level I), randomized controlled trials (RCTs) (Level I), prospective studies (Level II), retrospective studies (Level III), and case reports (Level IV) [18]. Level I and II were defined as high evidence levels.
Statistical analyses were performed with GraphPad Prism v. 7.0 (GraphPad, La Jolla, CA, USA). All tests were two-sided. The Spearman correlation coefficient was used to test correlations between selected continuous variables. Unpaired t tests were used to compare two different groups for parametric data and the Wilcoxon test was used for non-parametric data. p-Values of <0.05 were considered statistically significant. Visualized analysis for country collaboration of the top 50 cited articles was performed using VOSviewer 1.6.16 (Leiden University, Leiden, The Netherlands). Here, the line thickness between the colored dots indicates the total link strength, while the size of dots represents the number of publications in bibliographic coupling.

3. Results

3.1. Overall Trends

A total of 4464 publications and 53,111 citations from 684 journals on pediatric MIS between 1991 and 2020 were included in the analysis. The first pediatric laparoscopic, SILS (single-incision laparoscopic surgery), thoracoscopic, and robotic operations were published in 1991, 1993, and 2002, respectively [1,2,7,9,19]. The number of publications and citations per year constantly increased from 1991 to 2020, from seven and three, respectively, to 321 and 4666 in a similar matter (r = 0.96, p < 0.001), with the steepest increase between 2002 and 2009 (Figure 1). The number of publications correlated well with the number of citations during the last 30 years (r = 0.91, p < 0.0001).

3.2. 50 Most Cited Publications on MIS

The 50 most cited manuscripts were published between 1991 and 2013 and derived from 32 institutions in North America (n = 28), Europe (n = 19), and Asia (n = 3), as listed in Table 2. The United States of America holds the majority (27/50) of the global publication pattern (Figure 2) as well as the leading position in country-wise collaboration, owning eight total link strengths (Figure 3). The number of total citations ranged from 90 to 221 per paper (mean: 125 ± 38.1), with an average impact index of 15.9 ± 6.4. The most often cited article was published in 2006 by Richard S. Lee in the Journal of Urology (impact index: 6.8, IF: 7.5), comparing the safety and efficacy between robotic-assisted laparoscopic and open pyeloplasty in children, which showed comparable safety but longer operation time for the robotic procedure [20]. The second most often cited publication was from Keith E. Georgeson, published in 2000 in the Journal of Pediatric Surgery (impact index: 9.1, IF: 1.9), describing the laparoscopically-assisted anorectal pull-through (LAARP) as a new technique for the repair of high imperforate anus. The authors reported an excellent visualization of the rectal fistula and surrounding structures, accurate placement of the bowel through the anatomic midline and levator sling, and minimally invasive abdominal and perineal wounds [21].

3.3. Top Cited Journals and Impact Factor

The 50 most cited manuscripts were published in 12 journals with an IF ranging from 1.4 to 79.3. The Journal of Pediatric Surgery (n = 17; 34%; IF = 2.5), Journal of Urology (n = 12; 24%; IF = 7.5), and Annals of Surgery (n = 6; 12%; IF = 13.0) hosted 70% of the top cited papers. More than 50% of the top 50 citations were published with an IF > 2.5, and 14% with an IF > 10. The publication with the highest IF (The Lancet, IF = 79.3) was an RCT by Nigel J. Hall from 2009 reporting the outcome of open versus laparoscopic pyloromyotomy, indicating that both procedures were equally safe [22]. Moreover, the requirement of analgesics was significantly higher and parental satisfaction significantly lower after the open procedure. Thus, the authors recommended the minimally invasive approach in centers with sufficient laparoscopic experience.

3.4. Evidence Levels

The majority of the top 50 citations were retrospective studies (Level III; 66%) and case reports (Level IV; 12%), while the minority were published with high levels of evidence (I/II; 22%) (Figure 4). As a result, retrospective studies (Level III) and case reports (Level IV) accounted for more than 75% of the top 50 citations on pediatric MIS (Figure 5). Neither the IF (12.9 ± 22.5 vs. 5.2 ± 3.2; p = 0.46) nor the average number of citations (n = 125 ± 39.4 vs. n = 125 ± 34.7; p = 0.63) or mean impact index (14.0 ± 6.5 vs. 16.5 ± 6.4; p = 0.20) of high- and low-evidence level studies differed significantly.

3.5. Hot Topics

The majority of the 50 most cited papers reported on laparoscopic procedures (86%) (Figure 6; Table 2 and Table 3). Minimally invasive inguinal hernia repair (14%), appendectomy (8%), and pyloromyotomy (8%) dominated gastrointestinal interventions (50%). Pyeloplasty (18%), nephrectomy (6%), and ureteral reimplantation (6%) directed urological procedures (36%). Thoracoscopy was underrepresented (14%) and reported on the minimally invasive treatment of esophageal atresia (4%), congenital diaphragmatic hernia (4%), and empyema (4%).

4. Discussion

The absolute number of publications and citations on pediatric MIS increased during the last 30 years, with a steep rise between 2002 and 2009. This is in line with publications on other pediatric surgical topics such as esophageal atresia, anorectal malformations, and biliary atresia, and can be explained by the enhanced ambitions to share medical findings with the research community [16,23,24]. Moreover, research activity represents one of the most important factors to rate one’s academic value. Accordingly, a higher h-index correlates with a higher academic faculty rank [25].
In total, 32 institutions from three continents contributed to the 50 most cited articles on pediatric MIS. North America provided the majority of citations, which was also seen in other research topics such as neurocritical care and meniscal injury [26,27]. Additionally, the United States of America had the leading position in co-authorship country-wise collaborations and contributed the largest number of publications. This might be explained by the impact of science and technology budgets of this country and the financial support of organizations [28,29,30]. In general, countries with a high-income society accomplish more output of their research, while low- and middle-income countries publish relatively less scientific work [31].

4.1. Scientific Quality of the Top 50 Citations

The impact factor of the top 50 citations ranged from 1.4 to 79.3, with more than half of the manuscripts published in journals with an impact factor above 2.5, which equals the highest impact factor of pediatric surgery specific journals, i.e., the Journal of Pediatric Surgery. Thus, the majority of top 50 citations were published in non-pediatric surgery journals. This is in line with other research fields such as oncology, reporting that top cited papers are preferentially published in high-impact journals [32]. One may speculate that the most cited papers have profound influence on clinical practice or future developments also beyond a specific research field and are therefore published in more generalized journals with higher impact factors due to a broader audience [32]. Conversely, papers from journals with higher IF are preferentially cited, which may induce a publication bias [33].
The evidence level of a published study may be a superior quality parameter of the scientific work [34]. In the top 50 citations on pediatric MIS, studies with high impact, i.e., meta-analyses, RCTs, and prospective trials, were underrepresented. One meta-analysis summarized 23 studies on 6477 appendectomies, reporting lower rates of wound infection and ileus, shorter postoperative stay, as well as comparable operative time and complications for the laparoscopic approach [14]. The other one investigated the laparoscopic diagnosis of inguinal hernia [35]. The majority (78%) of the top 50 citations were retrospective studies and case reports, which is comparable to other bibliometric studies such as in orthopedic surgery [36,37]. Both approaches are important to investigate rare diseases, manifestations, and outcomes. However, their scientific value is limited: Some information may be missing, selection and recall biases can affect the results, and reasons for differences in treatment or loss of follow-ups can often not be ascertained [38]. Nevertheless, retrospective studies and also case reports require less time and lower budgets and can pave the way to define new research questions and prospective trials [39]. However, to underline the advantages of MIS in pediatric surgery, prospective and RCT trials, as the gold standard of effective research, are required [40].

4.2. Hot Topics of the Top 50 Citations

Being the earliest established and widely performed approach, laparoscopic interventions dominated the top 50 citations in our bibliometric study on pediatric MIS, while thoracoscopic interventions were less common. In the subgroup of abdominal and urologic interventions, minimally invasive pyeloplasty and inguinal hernia repair accounted for one-third of the top 50 citations.
Ureteropelvic junction obstruction (UPJO) occurs in 1 per 1.000–2.000 newborns, of which 10–20% undergo surgery later in life [41,42]. In 1993, Tan and his team reported on the first six children with UPJO treated by laparoscopic pyeloplasty. Five of them had normal or significantly improved drainage times postoperatively [43].
Nowadays, the laparoscopic approach is comparable to the open procedure with regards to safety and effectiveness [44]. However, despite similar complication rates and shorter lengths of stay, especially in children ≤ 2 years, UPJO is treated only in 25% of German patients laparoscopically. This could be explained by the challenging surgical technique as well as the low utilization of laparoscopy in non-teaching hospitals in Germany [45,46,47].
The cumulative incidence of inguinal hernia before the age of 15 is up to 7% in males and 1% in females [48]. Since the first laparoscopic inguinal hernia was reported by Montupet et al. in 1993, various minimally invasive procedures have been published [49]. Nowadays, the extraperitoneal approach is preferred worldwide [50]. According to a guideline of the European Pediatric Surgeon’s Association in 2022, laparoscopic inguinal hernia repair is beneficial for children with bilateral hernia, incarceration, and recurrence [51,52,53,54,55]. Accordingly, a recent systematic review on 13 RCTs reported on a shorter operative time for bilateral hernias, fewer post-operative complications and metachronous inguinal hernia rates for laparoscopic herniorrhaphy. No significant differences were found for unilateral operative time, time to full recovery, length of hospital stay, recurrence, and postoperative hydrocele [56].
In contrast to laparoscopy, thoracoscopic procedures accounted for only 14% of the top 50 citations on pediatric MIS. These papers mainly reported on neonatal thoracoscopy in EA, CDH, and thoracic empyema. The incidences of these diseases are low, and the surgical skills required to carry out these procedures are much higher than for routine laparoscopy [57,58,59]. Similarly, thoracoscopic MIS faces more obstacles of limited space, demanding anesthesia, and specialized instruments, especially in neonates [60]. Although the first thoracoscopic intervention for acute empyema was described as early as 1993, the first thoracoscopic procedures in CDH, EA, and congenital lung malformations were reported almost one decade later [7,60,61,62].

4.3. Establishing New Techniques in Pediatric MIS

When establishing a new technique in (MIS) surgery, different aspects need to be taken into account. First, the incidence of the disease should be high enough to pass your learning curve quickly. Second, the intervention itself should be well-defined and not exceed your surgical skills. Third, in case of technical difficulties, conversion to open surgery needs to be easy to prevent harm to the patient. Similarly, the conversion rate is an important parameter when evaluating new MIS procedures. Based on a German nationwide cohort study published in 2016, 75% of pediatric appendectomies were performed minimally invasively with a conversion rate of 1.2% [63]. In contrast, the reported conversion rate of thoracoscopic CDH and EA repair can be as high as 33–75% [64,65]. Technical difficulties, but also the effects of increased abdominal pressure, intraoperative hypercapnia, and acidosis, may contribute to the higher conversion rate in those cases [66].
The establishment of a new technique also depends on technical refinements, experience, individual learning curves, as well as the growing number of patients operated upon, i.e., experience, as well as results published. Most learning curve studies report a significant decrease in operative time as well as perioperative and postoperative complications with increasing experience of the surgeon [67]. The number of procedures a surgeon needs to pass his/her learning curve for perioperative and postoperative complications, recurrences, and conversion rates varies in different interventions. Similarly, one should perform 30, 20, 51, and 37 cases of laparoscopic inguinal hernia repair, laparoscopic pyloromyotomy, laparoscopic appendectomy, and robotic-assisted pyeloplasty, respectively, to get over his/her learning curve [68,69,70,71]. Moreover, experienced surgeons have lower complication rates and need to perform fewer cases to reach their plateau [68].
Although the first SILS and robotic-assisted interventions in children were published as early as in 1993 and 2002, respectively, none of the top 50 citations published on pediatric robotics or SILS [19]. This underlines the results from a survey among International Pediatric Endosurgery Group (IPEG) members stating that 80% perform SILS for cases of lower complexity such as appendectomy, although 70% of respondents find the scientific evidence for the benefits of SILS is not convincing [72].
Robotic interventions also require advanced surgical skills as well as appropriate equipment. Similarly, the first robotic surgery in a child, a Nissen fundoplication, was published almost 10 years after the first adult cases, and the spread of this new technique is relatively slower than that of other MIS techniques [73,74].

4.4. Limitations

Our study has several limitations. At first, only the Web of Science™ database was used to search for publications, thus, other sources may have led to a different number of research items or citation counts. Second, we aimed to identify only related articles on pediatric MIS, thus “title” instead of “topic” searching strategy was used. This might exclude some, but most likely an insignificant number of related articles. Finally, bibliometric studies always reflect the current state of the literature at the time of analysis and cannot rule out the impact of time with new publications and citations.

5. Conclusions

Research activity on pediatric MIS increased over the last 30 years, with a golden decade in the early 21st century. Laparoscopic pyeloplasty and inguinal hernia repair accounted for most of the top 50 citations. Retrospective trials and case reports dominated the evidence circulated. Studies with strong evidence are missing, especially on advanced techniques in pediatric MIS.

Author Contributions

Conceptualization: B.S., X.F., S.M., I.M. and M.L.; methodology: X.F., I.M. and B.S.; software: B.S. and X.F.; validation: X.F. and I.M.; formal analysis: B.S., X.F. and S.M.; data curation: B.S. and X.F.; writing—original draft preparation: B.S., X.F. and I.M.; writing—review and editing: S.M. and M.L.; visualization: B.S. and X.F.; supervision: S.M. and M.L.; project administration: S.M. and M.L. All authors have read and agreed to the published version of the manuscript.

Funding

B.S. received a scholarship from the Chinese government (Grant: 202108080166).

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

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Figure 1. Publication and citation trends on pediatric MIS between 1991 and 2020. The first pediatric laparoscopic, single-incision laparoscopic surgery (SILS), thoracoscopic, and robotic interventions were published in 1991, 1993, and 2002, respectively. The number of publications (red) and citations (blue) significantly increased over time, with the steepest increase between 2002 and 2009.
Figure 1. Publication and citation trends on pediatric MIS between 1991 and 2020. The first pediatric laparoscopic, single-incision laparoscopic surgery (SILS), thoracoscopic, and robotic interventions were published in 1991, 1993, and 2002, respectively. The number of publications (red) and citations (blue) significantly increased over time, with the steepest increase between 2002 and 2009.
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Figure 2. Choropleth map depicting the geographical distribution of the top 50 cited publications on pediatric MIS.
Figure 2. Choropleth map depicting the geographical distribution of the top 50 cited publications on pediatric MIS.
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Figure 3. Country-wise co-authorship collaborations of the top 50 cited publications on pediatric MIS.
Figure 3. Country-wise co-authorship collaborations of the top 50 cited publications on pediatric MIS.
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Figure 4. Evidence levels of the top 50 cited papers in pediatric MIS (1991 to 2020). The minority of manuscripts provided high evidence (n = 11; level I/II) and was published at a comparable mean citation rate and impact index as the 39 papers with lower evidence level (p > 0.05). Meta: meta-analysis; RCT: randomized controlled trial; N: total number of publications; C: total number of citations; IF: impact factor; II: impact index.
Figure 4. Evidence levels of the top 50 cited papers in pediatric MIS (1991 to 2020). The minority of manuscripts provided high evidence (n = 11; level I/II) and was published at a comparable mean citation rate and impact index as the 39 papers with lower evidence level (p > 0.05). Meta: meta-analysis; RCT: randomized controlled trial; N: total number of publications; C: total number of citations; IF: impact factor; II: impact index.
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Figure 5. Evidence levels of the 50 most cited papers on pediatric MIS (1991 to 2020). The top 50 cited papers were published from 1991 to 2013. Manuscripts of high- (level I/II; red) and low-evidence level (level III/IV; blue) were distributed equally over time.
Figure 5. Evidence levels of the 50 most cited papers on pediatric MIS (1991 to 2020). The top 50 cited papers were published from 1991 to 2013. Manuscripts of high- (level I/II; red) and low-evidence level (level III/IV; blue) were distributed equally over time.
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Figure 6. Hot topics of the 50 most cited papers on pediatric MIS (1991 to 2020). The majority of papers reported on laparoscopy (n = 43; 86%), with urologic interventions playing an important role (n = 18; 36%) in contrast to thoracoscopic procedures (n = 7; 14%).
Figure 6. Hot topics of the 50 most cited papers on pediatric MIS (1991 to 2020). The majority of papers reported on laparoscopy (n = 43; 86%), with urologic interventions playing an important role (n = 18; 36%) in contrast to thoracoscopic procedures (n = 7; 14%).
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Table 1. Inclusion and exclusion items of the Web of Science search.
Table 1. Inclusion and exclusion items of the Web of Science search.
“thoracoscopy” OR “thoracoscopic” OR “thoracoscopically” OR “laparoscopy” OR “laparoscopic” OR “laparoscopically” OR “minimal invasive surgery” OR “minimally invasive surgery” OR “robot assisted”
AND
“neonate” OR “neonates” OR “neonatal” OR “infant” OR “infants” OR “infancy” OR “preterm” OR “preterms” OR “newborn” OR “newborns” OR “pediatric” OR “pediatrics” OR “children” OR “child” OR “boy” OR “girl” OR “boys” OR “girls” OR “adolescent” OR “congenital” OR “atresia” OR “tracheoesophageal fistula” OR “necrotizing enterocolitis” OR “Hirschsprung disease” OR “anorectal malformation” OR “neuroblastoma” OR “hepatoblastoma” OR “nephroblastoma” OR “wilms” OR “orchidopexy” OR “pyloromyotomy” OR “Kasai” OR “imperforate anus”
NOT
“CHD” OR “patent ductus arteriosus” OR “PDA” OR “neurosurgery” OR “thalamic astrocytomas” OR “GAIT” OR “Palsy” OR “stereoelectroencephalography” OR “ASD” OR “Autism” OR “brain” OR “brainstem” OR “neuromotor” OR “attention-deficit hyperactivity disorder” OR “ADHD” OR “idiopathic scoliosis” OR “spinal” OR “spine”
Key words were selected for age of patients, specific MIS procedures, and MIS-specific diseases in infants, excluding congenital heart disease and skeletal, neurologic, and mental diseases.
Table 2. 50 most cited publications on pediatric MIS between 1991 and 2020 sorted by number of citations.
Table 2. 50 most cited publications on pediatric MIS between 1991 and 2020 sorted by number of citations.
Publication
First Author
JournalTotal Citations (n)YearImpact IndexImpact Factor (2020)Evidence LevelCountry
1Pediatric robot assisted laparoscopic dismembered pyeloplasty: Comparison with a cohort of open surgery
Lee RSJ Urol22120066.35.9retrospectiveUSA
2Laparoscopically assisted anorectal pull-through for high imperforate anus—A new technique
Georgeson KEJ Pediatr Surg22020009.11.9retrospectiveUSA
3Primary laparoscopic pull-through for hirschsprungs-disease in infants and children
Georgeson KEJ Pediatr Surg212199511.81.9case reportUSA
4Laparoscopic versus open appendectomy in children—A meta-analysis
Aziz OAnn Surg20520066.810.1meta analysisUK
5Pediatric laparoscopic dismembered pyeloplasty
Peters CAJ Urol193199513.05.9case reportUSA
6Single-port laparoscopic surgery: initial experience in children for varicocelectomy
Kaouk JHBJU Int18220086.64.8case reportUSA
7Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula—A multi-institutional analysis
Holcomb GWAnn Surg18220058.210.1retrospectiveUSA
8Congenital choledochal cyst: video-guided laparoscopic treatment
Farello GASurg Laparosc Endosc167199515.01.4case reportItaly
9Laparoscopic inguinal herniorrhaphy in children: A three-center experience with 933 repairs
Schier FJ Pediatr Surg164200211.01.9retrospectiveGermany
10Thoracoscopic decortication vs. tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial
St Peter SDJ Pediatr Surg15720097.01.9RCTUSA
11Laparoscopic inguinal hernia repair—a prospective personal series of 542 children
Schier FJ Pediatr Surg15520069.01.9prospectiveGermany
12Laparoscopic Anderson-Hynes dismembered pyeloplasty in children
Tan HLJ Urol151199913.95.9retrospectiveUK
13Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: clinical outcome of 972 repairs done in 3 pediatric surgical institutions
Takehara HJ Pediatr Surg14920069.41.9retrospectiveJapan
14Early Experience with Single-Port Laparoscopic Surgery in Children
Ponsky TAJ Laparoendosc Adv Surg Tech A14120097.81.4retrospectiveUSA
15Laparoscopic vesicoureteroplasty in children: initial case reports
Ehrlich RMUrology136199419.11.9case reportUSA
16A multi-institutional analysis of laparoscopic orchidopexy
Baker LABJU Int129200114.74.8retrospectiveUSA
17Laparoscopic treatment of congenital inguinal hernia in children
Montupet PJ Pediatr Surg126199916.71.9retrospectiveItaly
18Open versus laparoscopic pyloromyotomy for pyloric stenosis—A prospective, randomized trial
St Peter SDAnn Surg124200611.310.1RCTUSA
19Prospective, randomized, single-center, single-blind comparison of laparoscopic vs. open repair of pediatric inguinal hernia
Chan KLSurg Endosc123200512.23.1RCTPeoples R China
20Initial comparison of robotic-assisted laparoscopic versus open pyeloplasty in children
Yee DSUrology120200611.71.9retrospectiveUSA
21Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: A double-blind multicentre randomised controlled trial
Hall NJLancet11320099.760.4RCTUK
22Retroperitoneal laparoscopic versus open pyeloplasty in children
Bonnard AJ Urol112200513.46retrospectiveFrance
23Laparoscopic Sleeve Gastrectomy in 108 Obese Children and Adolescents Aged 5 to 21 Years
Alqahtani ARAnn Surg11120127.210.1retrospectiveSaudi Arabia
24Experience with 220 consecutive laparoscopic Nissen fundoplications in infants and children
Rothenberg SSJ Pediatr Surg110199820.01.9retrospectiveUSA
25Laparoscopic renal surgery via a retroperitoneal approach in children
El-Ghoneimi AJ Urol110199820.05.9retrospectiveFrance
26Is there a role for laparoscopic appendectomy in pediatric surgery?
Gilchrist BFJ Pediatr Surg109199225.71.9prospectiveUSA
27Thoracoscopic repair of tracheoesophageal fistula in newborns
Rothenberg SSJ Pediatr Surg108200216.71.9retrospectiveUSA
28Laparoscopic dismembered pyeloplasty by a retroperitoneal approach in children
El-Ghoneimi ABJU Int108200315.74.8retrospectiveFrance
29Robotic assisted laparoscopic pyeloplasty in children
Atug FJ Urol108200513.95.9retrospectiveUSA
30Laparoscopic evaluation of the pediatric inguinal hernia—A meta-analysis
Miltenburg DWJ Pediatr Surg109199821.01.9meta analysisUSA
31Pediatric laparoscopic splenectomy
Tulman SJ Pediatr Surg103199326.21.9case reportUSA
32Thoracoscopy in the management of empyema in children
Kern JAJ Pediatr Surg103199326.21.9retrospectiveUSA
33Robotic Assisted Laparoscopic Ureteral Reimplantation in Children: Case Matched Comparative Study With Open Surgical Approach
Marchini Giovanni SJ Urol10120118.95.9retrospectiveUSA
34Laparoscopic splenic procedures in children—Experience in 231 children
Rescorla FJAnn Surg100200713.010.1retrospectiveUSA
35Thoracoscopy Versus Thoracotomy Improves Midterm Musculoskeletal Status and Cosmesis in Infants and Children
Lawal Taiwo AAnn Thorac Surg100200911.03.6retrospectiveGermany
36Laparoscopic heminephroureterectomy in pediatric patients
Janetschek GJ Urol100199723.05.9retrospectiveAustria
37Laparoscopic transabdominal pyeloplasty in children is feasible irrespective of age
Metzelder MLJ Urol99200614.15.9retrospectiveGermany
38Hypercapnia and Acidosis During Open and Thoracoscopic Repair of Congenital Diaphragmatic Hernia and Esophageal Atresia Results of a Pilot Randomized Controlled Trial
Bishay MAnn Surg9720137.210.1RCTCanada
39Neonatal thoracoscopic repair of congenital diaphragmatic hernia: Selection criteria for successful outcome
Yang EYJ Pediatr Surg95200515.81.9retrospectiveUSA
40Extramucosal pyloromyotomy by laparoscopy
Alain JLSurg Endosc94199130.93.1retrospectiveFrance
41Retroperitoneal laparoscopic vs. open partial nephroureterectomy in children
El-Ghoneimi ABJU Int93200318.34.8retrospectiveFrance
42Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: A prospective, randomized controlled trial
Leclair MDJ Pediatr Surg92200714.11.9RCTFrance
43Single-blind randomized clinical trial of laparoscopic versus open appendicectomy in children
Lintula HBr J Surg91200124.25.7RCTFinland
44Laparoscopic herniorrhaphy in girls
Schier FJ Pediatr Surg91199820.91.9retrospectiveGermany
45One-trocar transumbilical laparoscopic-assisted appendectomy in children: Our experience
D’Alessio AEur J Pediatr Surg91200219.82.3retrospectiveItaly
46Experience with Modified Single-Port Laparoscopic Procedures in Children
Rothenberg SSJ Laparoendosc Adv Surg Tech A90200912.21.4retrospectiveUSA
47Complications in pediatric urological laparoscopy: Results of a survey
Peters CAJ Urol90199626.75.9retrospectiveUSA
48Laparoscopic pyeloplasty in the infant younger than 6 months—Is it technically possible?
Kutikov AJ Urol90200615.65.9retrospectiveUSA
49Initial experience with laparoscopic transvesical ureteral reimplantation at the Children’s Hospital of Philadelphia
Kutikov AJ Urol90200615.65.9retrospectiveUSA
50Should laparoscopic appendectomy be avoided for complicated appendicitis in children?
Horwitz JRJ Pediatr Surg90199725.61.9retrospectiveUSA
Table 3. 50 most cited publications on pediatric MIS between 1991 and 2020 sorted by impact index. The lower the impact index, the higher the citation rate since publication, thus indicating an augmented recognition.
Table 3. 50 most cited publications on pediatric MIS between 1991 and 2020 sorted by impact index. The lower the impact index, the higher the citation rate since publication, thus indicating an augmented recognition.
Publication
First Author
JournalTotal Citations (n)YearImpact
Index
Impact Factor (2020)Evidence LevelCountry
1Pediatric Robot Assisted Laparoscopic Dismembered Pyeloplasty: Comparison with a Cohort of Open Surgery
Lee RSJ Urol22120066.35.9retrospectiveUSA
2Single-Port Laparoscopic Surgery: Initial Experience in Children for Varicocelectomy
Kaouk JHBJU Int18220086.64.8case reportUSA
3Laparoscopic Versus Open Appendectomy in Children—A Meta-Analysis
Aziz OAnn Surg20520066.810.1meta-analysisUK
4Thoracoscopic Decortication Vs. Tube Thoracostomy with Fibrinolysis for Empyema in Children: A Prospective, Randomized Trial
St Peter SDJ Pediatr Surg157200971.9RCTUSA
5Laparoscopic Sleeve Gastrectomy in 108 Obese Children and Adolescents Aged 5 to 21 Years
Alqahtani ARAnn Surg11120127.210.1retrospectiveSaudi Arabia
6Hypercapnia and Acidosis During Open and Thoracoscopic Repair of Congenital Diaphragmatic Hernia and Esophageal Atresia Results of a Pilot Randomized Controlled Trial
Bishay MAnn Surg9720137.210.1RCTCanada
7Early Experience with Single-Port Laparoscopic Surgery in Children
Ponsky TAJ Laparoendosc Adv Surg Tech A14120097.81.4retrospectiveUSA
8Thoracoscopic Repair of Esophageal Atresia and Tracheoesophageal Fistula—A Multi-Institutional Analysis
Holcomb GWAnn Surg18220058.210.1retrospectiveUSA
9Robotic Assisted Laparoscopic Ureteral Reimplantation in Children: Case Matched Comparative Study with Open Surgical Approach
Marchini Giovanni SJ Urol10120118.95.9retrospectiveUSA
10Laparoscopic Inguinal Hernia Repair—A Prospective Personal Series of 542 Children
Schier FJ Pediatr Surg155200691.9prospectiveGermany
11Laparoscopically Assisted Anorectal Pull-Through for High Imperforate Anus—A New Technique
Georgeson KEJ Pediatr Surg22020009.11.9retrospectiveUSA
12Laparoscopic Percutaneous Extraperitoneal Closure for Inguinal Hernia in Children: Clinical Outcome Of 972 Repairs Done In 3 Pediatric Surgical Institutions
Takehara HJ Pediatr Surg14920069.41.9retrospectiveJapan
13Recovery After Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis: A Double-Blind Multicentre Randomised Controlled Trial
Hall NJLancet11320099.760.4RCTUK
14Laparoscopic Inguinal Herniorrhaphy In Children: A Three-Center Experience With 933 Repairs
Schier FJ Pediatr Surg1642002111.9retrospectiveGermany
15Thoracoscopy Versus Thoracotomy Improves Midterm Musculoskeletal Status and Cosmesis in Infants And Children
Lawal Taiwo AAnn Thorac Surg1002009113.6retrospectiveGermany
16Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis—A Prospective, Randomized Trial
St Peter SDAnn Surg124200611.310.1RCTUSA
17Initial Comparison Of Robotic-Assisted Laparoscopic Versus Open Pyeloplasty in Children
Yee DSUrology120200611.71.9retrospectiveUSA
18Primary Laparoscopic Pull-Through for Hirschsprungs-Disease In Infants and Children
Georgeson KEJ Pediatr Surg212199511.81.9case reportUSA
19Prospective, Randomized, Single-Center, Single-Blind Comparison of Laparoscopic Vs. Open Repair of Pediatric Inguinal Hernia
Chan KLSurg Endosc123200512.23.1RCTPeoples R China
20Experience with Modified Single-Port Laparoscopic Procedures in Children
Rothenberg SSJ Laparoendosc Adv Surg Tech A90200912.21.4retrospectiveUSA
21Pediatric Laparoscopic Dismembered Pyeloplasty
Peters CAJ Urol1931995135.9case reportUSA
22Laparoscopic Splenic Procedures in Children—Experience in 231 Children
Rescorla FJAnn Surg10020071310.1retrospectiveUSA
23Retroperitoneal Laparoscopic Versus Open Pyeloplasty in Children
Bonnard AJ Urol112200513.46retrospectiveFrance
24Laparoscopic Anderson-Hynes Dismembered Pyeloplasty in Children
Tan HLJ Urol151199913.95.9retrospectiveUK
25Robotic Assisted Laparoscopic Pyeloplasty in Children
Atug FJ Urol108200513.95.9retrospectiveUSA
26Laparoscopic Transabdominal Pyeloplasty in Children Is Feasible Irrespective of Age
Metzelder MLJ Urol99200614.15.9retrospectiveGermany
27Laparoscopic Pyloromyotomy for Hypertrophic Pyloric Stenosis: A Prospective, Randomized Controlled Trial
Leclair MDJ Pediatr Surg92200714.11.9RCTFrance
28A Multi-Institutional Analysis of Laparoscopic Orchidopexy
Baker LABJU Int129200114.74.8retrospectiveUSA
29Congenital Choledochal Cyst: Video-Guided Laparoscopic Treatment
Farello GASurg Laparosc Endosc1671995151.4case reportItaly
30Laparoscopic pyeloplasty in the infant younger than 6 months—Is it technically possible?
Kutikov AJ Urol90200615.65.9retrospectiveUSA
31Initial experience with laparoscopic transvesical ureteral reimplantation at the Children’s Hospital of Philadelphia
Kutikov AJ Urol90200615.65.9retrospectiveUSA
32Laparoscopic Dismembered Pyeloplasty by a Retroperitoneal Approach in Children
El-Ghoneimi ABJU Int108200315.74.8retrospectiveFrance
33Neonatal Thoracoscopic Repair of Congenital Diaphragmatic Hernia: Selection Criteria for Successful Outcome
Yang EYJ Pediatr Surg95200515.81.9retrospectiveUSA
34Laparoscopic Treatment of Congenital Inguinal Hernia in Children
Montupet PJ Pediatr Surg126199916.71.9retrospectiveItaly
35Thoracoscopic Repair of Tracheoesophageal Fistula in Newborns
Rothenberg SSJ Pediatr Surg108200216.71.9retrospectiveUSA
36Retroperitoneal Laparoscopic Vs. Open Partial Nephroureterectomy in Children
El-Ghoneimi ABJU Int93200318.34.8retrospectiveFrance
37Laparoscopic Vesicoureteroplasty in Children: Initial Case Reports
Ehrlich RMUrology136199419.11.9case reportUSA
38One-Trocar Transumbilical Laparoscopic-Assisted Appendectomy in Children: Our Experience
D’Alessio AEur J Pediatr Surg91200219.82.3retrospectiveItaly
39Experience with 220 Consecutive Laparoscopic Nissen Fundoplications in Infants and Children
Rothenberg SSJ Pediatr Surg1101998201.9retrospectiveUSA
40Laparoscopic Renal Surgery Via a Retroperitoneal Approach in Children
El-Ghoneimi AJ Urol1101998205.9retrospectiveFrance
41Laparoscopic Herniorrhaphy in Girls
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Shu, B.; Feng, X.; Martynov, I.; Lacher, M.; Mayer, S. Pediatric Minimally Invasive Surgery—A Bibliometric Study on 30 Years of Research Activity. Children 2022, 9, 1264. https://doi.org/10.3390/children9081264

AMA Style

Shu B, Feng X, Martynov I, Lacher M, Mayer S. Pediatric Minimally Invasive Surgery—A Bibliometric Study on 30 Years of Research Activity. Children. 2022; 9(8):1264. https://doi.org/10.3390/children9081264

Chicago/Turabian Style

Shu, Boshen, Xiaoyan Feng, Illya Martynov, Martin Lacher, and Steffi Mayer. 2022. "Pediatric Minimally Invasive Surgery—A Bibliometric Study on 30 Years of Research Activity" Children 9, no. 8: 1264. https://doi.org/10.3390/children9081264

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