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Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies
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Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Surgery".

Deadline for manuscript submissions: 5 May 2026 | Viewed by 6627

Special Issue Editors

Dr. Donatella Di Fabrizio

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Guest Editor
Pediatric Surgery Unit, Salesi Children’s Hospital, Polytechnic University of Marche, Via Filippo Corridoni, 16, 60123 Ancona, Italy
Interests: minimally invasive surgery; robotic surgery; neonatal surgery; pediatric oncologic surgery
Dr. Edoardo Bindi

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Guest Editor
Department of Odontostomatologic and Specialized Clinical Sciences (DISCO), Marche Polytechnic University, Pediatric Surgery Unit Salesi Children’s Hospital, 60121 Ancona, AN, Italy
Interests: minimally invasive surgery; thoracic surgery; pediatric urology; robot-assisted surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Giovanni Cobellis

E-Mail Website
Guest Editor
Department of Pediatric Surgery, University Politecnica of Marche, Ospedale Pediatrico G. Salesi, AOU delle Marche, Via Filippo Corridoni, 11, 60123 Ancona, AN, Italy
Interests: pediatric surgery; laparoscopic surgery; robot-assisted surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As the Guest Editor of this Special Issue, entitled “Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies”, I am pleased to invite you to submit your work to the journal Children.

Pediatric surgery has undergone remarkable advancements in recent years, driven by the continuous evolution of minimally invasive techniques, robotics, artificial intelligence, and imaging technologies. These innovations are transforming the surgical management of complex conditions, enabling greater precision, reducing morbidity, and improving long-term outcomes. As technology continues to expand the frontiers of pediatric surgical care, it is essential to explore its applications, benefits, and challenges to enhance patient outcomes.

This Special Issue aims to serve as a platform for cutting-edge research in pediatric surgery, showcasing novel approaches and technological breakthroughs that are shaping the future of the field. We welcome contributions that explore innovative surgical techniques, emerging technologies, and their clinical applications. Topics of interest include minimally invasive and robotic-assisted surgery, AI-driven surgical decision-making, fluorescence-guided imaging, 3D printing for preoperative planning, augmented reality in surgery, and advancements across all fields of pediatric surgery.

We encourage the submission of original research articles, systematic reviews, meta-analyses, and clinical studies that contribute to the advancement of pediatric surgical care.

Dr. Donatella Di Fabrizio
Dr. Edoardo Bindi
Prof. Dr. Giovanni Cobellis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric surgery innovations
  • minimally invasive surgery
  • robotic-assisted surgery
  • artificial intelligence in surgery
  • 3D printing in surgical planning
  • fluorescence-guided imaging
  • augmented reality in surgery
  • smart surgical technologies

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Published Papers (10 papers)

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Research

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12 pages, 926 KB  
Article
Enhanced Recovery After Surgery for Pediatric Lung Resection: Effects of a New Protocol
by Andrew J. Behrmann, Elizabeth A. Shumway, Brooklyn Campbell, Cannon Dew, Tara Kempker, Jessica Peuterbaugh, Venkataraman Ramachandran, Yousef El-Gohary and Ahmed I. Marwan
Children 2025, 12(12), 1658; https://doi.org/10.3390/children12121658 - 7 Dec 2025
Viewed by 117
Abstract
Background: Prenatal detection of congenital lung lesions has increased with improved imaging. These abnormalities are safely treated with thoracoscopic lobectomy. We implemented an enhanced recovery after surgery (ERAS) protocol to standardize care and aim to evaluate its safety and efficacy compared to [...] Read more.
Background: Prenatal detection of congenital lung lesions has increased with improved imaging. These abnormalities are safely treated with thoracoscopic lobectomy. We implemented an enhanced recovery after surgery (ERAS) protocol to standardize care and aim to evaluate its safety and efficacy compared to a non-ERAS cohort. Methods: A single-center retrospective chart review was conducted for twenty patients (n = 10 ERAS, n = 10 non-ERAS) undergoing thoracoscopic lobectomy from 2014–2024. Results: ERAS patients were generally younger at the time of surgery (ERAS: 4.25 ± 2.76 months vs. non-ERAS: 6.45 ± 6.78 months, p = 0.17). Postoperative length of stay was shorter in ERAS (1.77 ± 0.60 days) vs. non-ERAS patients (5.25 ± 3.79 days, p = 0.03) as well as chest tube duration (ERAS: 1.44 ± 0.73 days vs. non-ERAS 3.64 ± 2.38 days, p = 0.01). ERAS patients received lower amounts of opioid analgesics compared to non-ERAS (p = 0.0046). Use of the ERAS protocol also decreased cost for the healthcare system compared to non-ERAS patients (p = 0.0037). ERAS patients had no reintubations or prolonged air leaks (defined as >48 h), compared to four reintubations (p = 0.04) and three prolonged air leaks (p = 0.07) in the non-ERAS group. Crucially, there were no complications in the ERAS group, whereas five non-ERAS patients experienced Clavien–Dindo level III (one IIIa, two IIIb, two IVa) complications (p = 0.02). Conclusions: Our preliminary findings demonstrate the successful integration of a novel ERAS protocol in pediatric thoracoscopic lobectomies and its efficacy in reducing standard post-operative recovery times without an increased rate of complications. Earlier discharge in the ERAS group constitutes less healthcare burden with improved resource utilization and less family, work, and social disruption. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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10 pages, 236 KB  
Article
Seeing Beyond the Microscope: Artificial Intelligence and Fluorescence Confocal Digital Imaging in Pediatric Surgical Pathology
by Donatella Di Fabrizio, Gloria Daziani, Ilir Qose, Edoardo Bindi, Michele Ilari, Alessandra Filosa, Francesco Paolo Busardò, Gaia Goteri and Giovanni Cobellis
Children 2025, 12(12), 1608; https://doi.org/10.3390/children12121608 - 26 Nov 2025
Viewed by 293
Abstract
Background: Digital pathology (DP) combined with fluorescence confocal microscopy (FCM) allows rapid tissue assessment while preserving specimens. Artificial intelligence (AI) and large language models (LLMs) may enhance diagnostic workflows, but their role in pediatric surgical pathology is largely unexplored. Methods: We conducted [...] Read more.
Background: Digital pathology (DP) combined with fluorescence confocal microscopy (FCM) allows rapid tissue assessment while preserving specimens. Artificial intelligence (AI) and large language models (LLMs) may enhance diagnostic workflows, but their role in pediatric surgical pathology is largely unexplored. Methods: We conducted a prospective, single-center study including 20 pediatric surgical cases with ex vivo FCM images acquired intraoperatively. Two commercially available LLMs, GPT-4V (AnPathology-Gpt) and Claude 3.7 Sonnet (AnPathology Project), were tested using structured prompts to generate diagnostic reports with and without immunohistochemistry (IHC) data, when available. Outputs were compared against the gold standard diagnosis by an experienced pediatric pathologist. Diagnostic performance was evaluated through accuracy, sensitivity, specificity, and Cohen’s kappa. A paired sub-analysis was performed for cases with IHC (n = 5), and a sensitivity analysis excluding IHC cases (n = 15) was conducted. Results: Across all 20 cases, AnPathology-Gpt achieved 85% accuracy, 100% sensitivity, 86% specificity, and κ = 0.78, while AnPathology Project reached 80% accuracy, 100% sensitivity, 57% specificity, and κ = 0.63. Both models correctly identified all 13 neoplastic cases, with errors limited to non-neoplastic lesions mimicking tumors. In the IHC sub-analysis, accuracy improved from 40% to 80% and sensitivity from 50% to 100% for both models, resolving two false negatives observed in the FCM-only evaluation. Sensitivity analysis excluding IHC confirmed consistency of the results. Conclusions: This pilot study demonstrates that multimodal LLMs can support accurate and rapid diagnosis in pediatric digital pathology. The addition of IHC improves performance in diagnostically complex cases. Larger multicenter studies are needed to validate these findings and to define the role of AI-assisted workflows in pediatric surgical pathology. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
9 pages, 883 KB  
Article
Gynecomastia Outpatient Surgical Treatment in Children Without Closed-Suction Drain Placement: Is It Safe and Effective?
by Carlos Delgado-Miguel, Ennio Fuentes, Pablo Aguado and Ricardo Díez
Children 2025, 12(11), 1571; https://doi.org/10.3390/children12111571 - 19 Nov 2025
Viewed by 309
Abstract
Introduction: Idiopathic gynecomastia is a common diagnosis among adolescents. Closed-suction drain placement after breast resection is traditionally performed to prevent complications such as seroma or hematoma, although its effectiveness remains controversial. Drains are also associated with patient discomfort and may require prolonged wound [...] Read more.
Introduction: Idiopathic gynecomastia is a common diagnosis among adolescents. Closed-suction drain placement after breast resection is traditionally performed to prevent complications such as seroma or hematoma, although its effectiveness remains controversial. Drains are also associated with patient discomfort and may require prolonged wound care. The aim of the present study is to describe our experience with the outpatient surgical treatment of adolescent gynecomastia without closed-suction drain placement and to assess its short- and long-term outcomes. Methods: We conducted a retrospective single-center cohort study including male patients under 18 years of age operated on for idiopathic gynecomastia between 2019 and 2023. Demographic data, clinical features (grade of gynecomastia according to Simon’s classification before surgery), intraoperative variables, and postoperative outcomes were collected. Patients were followed in the outpatient setting, with assessment of early (<30 days) and late complications. Results: A total of 21 consecutive patients were included, with a median age of 14.5 years (range 13.6–17.4). Sixteen patients (76.2%) underwent bilateral mastectomies, and five (23.8%) underwent unilateral subtotal mastectomies. Gynecomastia grade was I in 6 cases (28.6%), II in 12 (57.1%), and III in 3 (14.3%). No intraoperative adverse events occurred. Compressive chest bandaging was performed without closed-suction drainage. All patients were discharged on the same day. Two patients (9.5%) developed mild seroma during follow-up, both resolving spontaneously without aspiration or surgery. Conclusions: Our preliminary findings suggest that outpatient gynecomastia surgery without closed-suction drains appears to be a safe and effective option in adolescents, minimizing discomfort and avoiding hospital admission. However, larger, multicenter comparative studies are warranted to confirm these results and to further evaluate patient satisfaction and long-term cosmetic outcomes. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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19 pages, 4997 KB  
Article
Subtalar Arthroereisis with Calcaneus Stop Screws—Can the Angles on Pre- and Post-Surgical X-Ray Images Be Reliably Measured by Artificial Intelligence?
by Lea Alexandra Simmler, Monika Herten, Samuel Hohenberger, Cedric Rubenthaler, Heinz-Lothar Meyer, Bastian Mester, Stephanie Herbstreit, Johannes Haubold, Manuel Burggraf, Marcel Dudda and Christina Polan
Children 2025, 12(11), 1552; https://doi.org/10.3390/children12111552 - 17 Nov 2025
Viewed by 339
Abstract
Background/Objectives: Flexible symptomatic flat foot in children can be surgically treated with calcaneus stop screws. This raises the question of whether pre- and postoperative radiographs (X-ray) can be analyzed in two planes using AI. Methods: In this monocentric retrospective study, angle [...] Read more.
Background/Objectives: Flexible symptomatic flat foot in children can be surgically treated with calcaneus stop screws. This raises the question of whether pre- and postoperative radiographs (X-ray) can be analyzed in two planes using AI. Methods: In this monocentric retrospective study, angle measurements generated by Bone Metrics AI (Gleamer) were compared with manual measurements using Centricity™ (GE Healthcare). A total of 659 X-rays from 124 operated feet (2014–2024) were available, of which 422 were analyzable by AI and 299 met defined quality criteria. Bland–Altman plots were used to assess agreement. Linear and logistic regression analysis examined the influence of age, gender, accessory navicular bone, additional foot pathologies, and flat foot severity on comparability of the measurement methods and measurability by the AI. Finally, radiographs meeting and missing quality criteria were compared. Results: AI measurements were comparable to manual measurements for calcaneus inclination, hallux valgus, 1st–2nd and 1st–5th metatarsal angle both pre- and post-operatively. For the talus-1st metatarsal and medial arch angles, AI results differed significantly (p < 0.001 and p ≤ 0.013) from manual measurement. AI generated talus-1st metatarsal angle was measured larger by 6.14°, 95% [−7.14; −5.14] pre-operatively and 2.80°, 95% [−3.79; −1.81] post-operatively. Medial arch angle was smaller by 1.63° pre-operatively, 95% [1.03; 2.23] and 0.52° post-operatively, 95% CI [0.11; 0.93] with AI. Post-operative measurability was not significantly lower than pre-operative. AI measured angles on incorrectly taken radiographs as often or more often than on correctly taken ones. Discussion: Screw implantation did not negatively impair measurability or AI accuracy. However, age, gender, and flat foot severity influenced AI performance. Bad radiograph quality did not affect AI measurability negatively, indicating that AI cannot yet distinguish between X-rays suitable and unsuitable for angle measurements. Conclusions: Manual measurements are still indispensable in the diagnosis of children’s flat feet. In the future, continuous training of the AI is expected to bring it into line with manually measured radiological values. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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12 pages, 1344 KB  
Article
The Short-Term Impact of Decompressive Craniectomy in Pediatric Patients with Severe Traumatic Brain Injury: A Retrospective Matched Cohort Study
by Jingjing Xu, Run Zhou, Jing Li, Chengjun Liu and Hongxing Dang
Children 2025, 12(10), 1374; https://doi.org/10.3390/children12101374 - 11 Oct 2025
Viewed by 803
Abstract
Background/Objectives: Decompressive craniectomy (DC) is commonly applied to manage refractory intracranial hypertension in severe traumatic brain injury (TBI). However, its role and benefits in pediatric populations remain uncertain. Clarifying whether DC provides measurable clinical advantages in children with severe TBI may inform [...] Read more.
Background/Objectives: Decompressive craniectomy (DC) is commonly applied to manage refractory intracranial hypertension in severe traumatic brain injury (TBI). However, its role and benefits in pediatric populations remain uncertain. Clarifying whether DC provides measurable clinical advantages in children with severe TBI may inform treatment strategies and family counseling. Methods: We conducted a retrospective, one-to-one matched cohort study at a tertiary pediatric center (2014–2023). Fifty-three children with severe TBI who underwent DC were matched with fifty-three non-DC patients based on age, Glasgow Coma Scale score, cranial CT findings, and pupillary response at admission to ensure comparable injury severity. Demographic data, clinical features, and outcomes were collected. Primary outcomes were in-hospital mortality and Pediatric Cerebral Performance Category (PCPC) scores at discharge and 3 months. Secondary outcomes included duration of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay. Results: Mortality did not differ significantly between DC and non-DC groups (17.0% vs. 26.4%, p = 0.239). DC patients had better PCPC scores at discharge (p = 0.029). At 3 months, the between-group difference was not statistically significant but showed a near-significant trend (p = 0.057). No significant differences were observed in duration of ventilation (p = 0.100), ICU stay (p = 0.348), or hospital stay (p = 0.678). Conclusions: DC may not reduce short-term mortality in pediatric severe TBI but appears to be associated with more favorable neurological outcomes at discharge. Larger, adequately powered studies with standardized monitoring and longer follow-up are needed to clarify the durability and scope of potential benefits in this population. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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9 pages, 1344 KB  
Article
Bleomycin Electrosclerotherapy for Peripheral Low-Flow Venous and Lymphatic Malformations in Children: A Monocentric Case Series
by Edoardo Guida, Alessandro Boscarelli, Zeljko Zovko, Matea Peric-Anicic, Marianna Iaquinto, Maria-Grazia Scarpa, Sonia Maita, Damiana Olenik, Daniela Codrich and Jürgen Schleef
Children 2025, 12(9), 1167; https://doi.org/10.3390/children12091167 - 1 Sep 2025
Viewed by 1143
Abstract
Background: Vascular malformations are relatively common in children. Current therapeutic strategies include observation, medical therapy, sclerotherapy or embolization, laser therapy, cryoablation, and surgery, depending on the type and anatomical location of the malformation. Surgery is commonly limited to small and/or circumscribed lesions, to [...] Read more.
Background: Vascular malformations are relatively common in children. Current therapeutic strategies include observation, medical therapy, sclerotherapy or embolization, laser therapy, cryoablation, and surgery, depending on the type and anatomical location of the malformation. Surgery is commonly limited to small and/or circumscribed lesions, to debulking in case of large volumes, or in drug-resistant cases. Sclerotherapy is a minimally invasive treatment generally used to treat dysplastic vasculature and to significantly improve patients’ symptoms. Herein, we describe our preliminary experience with bleomycin electrosclerotherapy (BEST) in the treatment of peripheral low-flow venous and lymphatic malformations in the pediatric population. Methods: We prospectively collected and analyzed data from patients who underwent BEST for peripheral low-flow vascular malformations (venous and lymphatic) and were treated at our institution from May 2022 onward. Results: Twelve patients (4 boys and 8 girls) with peripheral low-flow vascular malformations who underwent BEST were enrolled in this preliminary study. The median patient age at the first procedure was 81 months (IQR = 46–128). The most frequent anomaly was peripheral low-flow venous malformation. No relevant postoperative complications were encountered in any of the patients. All patients underwent a clinical evaluation of the malformation 1 month after the procedure. A clinical and ultrasonographic evaluation of the malformation was performed 2 months after the procedure to determine whether to repeat BEST. In cases of clinical resolution, a second ultrasonographic evaluation was performed 6 months after the procedure. Conclusions: BEST appears to be a promising and safe option for treating peripheral low-flow vascular malformations in children. Further studies with a greater number of patients and longer follow-up periods are needed to confirm our preliminary experience. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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12 pages, 3647 KB  
Article
Impact of Intracystic Hemorrhage on Therapeutic Outcomes in Macro/Mixed Cystic Lymphatic Malformation: A Retrospective Cohort Study
by Tao Han, Daolin Ye, Jie Cui, Songming Huang and Weimin Shen
Children 2025, 12(7), 935; https://doi.org/10.3390/children12070935 - 16 Jul 2025
Viewed by 589
Abstract
Objectives: This research aims to examine the impact of intracystic hemorrhage (ICH) on therapeutic outcomes in children with macro or mixed cystic lymphatic malformation (cLM). Methods: This retrospective study included macro/mixed cLM cases with or without ICH who underwent treatment between [...] Read more.
Objectives: This research aims to examine the impact of intracystic hemorrhage (ICH) on therapeutic outcomes in children with macro or mixed cystic lymphatic malformation (cLM). Methods: This retrospective study included macro/mixed cLM cases with or without ICH who underwent treatment between January 2019 and June 2024. All patients were diagnosed using preoperative imaging findings and intraoperative indocyanine green (ICG) lymphography. The baseline data of enrolled cases were retrospectively collected. The clinical characteristics were documented, including gender, age, histological typing, location, maximum diameter, and intracystic condition. Patients with or without ICH were divided into two groups. The dependent variables for predicting an excellent outcome were analyzed using multivariable logistic regression models after adjusting for potential factors using a univariable regression model. Postoperative variables, including duration of negative drainage, local infection, scar hyperplasia, and follow-up, were compared between the two groups. Results: A total of 83 cLM patients were included (ICH group: n = 36 and without ICH group: n = 47). A complete absence of afferent lymphatic vessels was demonstrated using intraoperative ICG lymphography, suggesting the isolated nature of ICH cases. ICH (p = 031; OR, 2.560; 95% CI, 1.089–6.020) was identified as the main predictor, and younger patients (p = 035; OR, 0.415; 95% CI, 0.183–0.940) had a lower potential for excellent outcomes. For the postoperative variables, the ICH group exhibited a shorter duration of negative drainage than the without ICH group (p < 0.001), while no significant differences were found regarding local infection (p = 0.693) and scar hypertrophy (p = 0.648). Conclusions: Although characterized by aggressive progression and compressive symptoms, ICH emerges as an independent favorable prognostic predictor in macro/mixed cLM management, potentially attributable to its isolated nature. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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Review

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14 pages, 2327 KB  
Review
Aorto-Esophageal Fistula Secondary to Foreign Body Ingestion in Children: A Novel Treatment Approach and Comprehensive Narrative Review
by Marco Di Mitri, Gabriele Egidy Assenza, Francesco Dimitri Petridis, Sara Schirru, Marta Agulli, Maria Elisabetta Mariucci, Emanuela Angeli, Edoardo Collautti, Tommaso Gargano, Mario Lima and Andrea Donti
Children 2025, 12(12), 1672; https://doi.org/10.3390/children12121672 - 9 Dec 2025
Viewed by 32
Abstract
Background: Aorto-esophageal fistula (AEF) is a rare but life-threatening condition in children following foreign body (FB) ingestion, with button batteries (BB) being the most dangerous. These batteries involve severe tissue necrosis due to chemical and electrical reactions, often leading to fistula formation [...] Read more.
Background: Aorto-esophageal fistula (AEF) is a rare but life-threatening condition in children following foreign body (FB) ingestion, with button batteries (BB) being the most dangerous. These batteries involve severe tissue necrosis due to chemical and electrical reactions, often leading to fistula formation and catastrophic hemorrhage. Appropriate treatment for AEF is still undefined. Method: This report presents a novel case of AEF closure using a covered stent in a 4-year-old boy, complemented by a narrative review of 36 reported pediatric AEF cases from 1988 to 2024. Results: The review revealed that BB ingestion accounted for 67% of AEF cases, with a high mortality rate of 43%, underscoring the critical nature of this condition. Early symptoms are often nonspecific, leading to delayed diagnoses, which worsen outcomes. Computed tomography (CT) is the key imaging modality for detecting vascular complications such as AEF, while X-ray may help identify the foreign body, but is often insufficient to assess associated injuries. While surgical repair remains the mainstay of treatment, minimally invasive techniques, such as endovascular approaches, are emerging as viable options. Conclusions: This study highlights the need for heightened public awareness, safer battery designs, and prompt, multidisciplinary interventions to improve patient outcomes. Future research should focus on refining diagnostic protocols, evaluating innovative management strategies, and establishing comprehensive registries to inform evidence-based guidelines and optimize care. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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19 pages, 1061 KB  
Review
Salivary Biomarkers in Pediatric Acute Appendicitis: Current Evidence and Future Directions
by Zenon Pogorelić, Miro Jukić, Tomislav Žuvela, Klaudio Pjer Milunović, Ivan Maleš, Ivan Lovrinčević and Jasenka Kraljević
Children 2025, 12(10), 1342; https://doi.org/10.3390/children12101342 - 6 Oct 2025
Cited by 1 | Viewed by 877
Abstract
Background: Acute appendicitis is the most common surgical emergency in children, yet timely and accurate diagnosis remains challenging due to nonspecific clinical presentations and limitations of imaging and blood tests. Saliva has emerged as a promising diagnostic medium because it is non-invasive, painless, [...] Read more.
Background: Acute appendicitis is the most common surgical emergency in children, yet timely and accurate diagnosis remains challenging due to nonspecific clinical presentations and limitations of imaging and blood tests. Saliva has emerged as a promising diagnostic medium because it is non-invasive, painless, inexpensive, and highly acceptable for pediatric patients. Salivary biomarkers may provide rapid and child-friendly adjuncts to existing diagnostic pathways. Methods: A systematic literature search was performed in Ovid/MEDLINE, Scopus, Web of Science, and the Cochrane Library to identify studies assessing salivary biomarkers in pediatric appendicitis. Eligible studies included children with suspected or confirmed appendicitis and evaluated the diagnostic accuracy of salivary markers compared to clinical, laboratory, or imaging standards. Results: To date, only three salivary biomarkers have been investigated. Leucine-rich α-2-glycoprotein 1 (LRG1) demonstrated high specificity of 100% but low sensitivity of 35–36%, with diagnostic accuracy ranging from AUC 0.77 to 0.85. C-reactive protein (CRP) showed excellent diagnostic performance with sensitivity of 91.3% and specificity of 95.4% (AUC 0.97), and strong correlation with serum CRP (ρ = 0.96). Irisin showed sensitivity of 90% and specificity of 60% with estimated AUC around 0.75, suggesting potential as an adjunct marker but limited as a standalone test. Conclusions: Salivary biomarkers in pediatric appendicitis are promising but remain underexplored, with evidence limited to small, single-center studies totalling fewer than 300 patients. Their advantages include feasibility, tolerability, and suitability for integration into point-of-care testing. Future research should focus on multicenter validation, development of multi-marker salivary panels, and application of biosensor technologies. With further evidence, salivary diagnostics could complement existing strategies and improve the accuracy and child-friendliness of appendicitis care. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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32 pages, 3916 KB  
Review
Advances in Fluorescent Adjuncts in Pediatric Surgery: A Comprehensive Review of Applications of Indocyanine Green Across Surgical Specialties
by Nicholas Jose Iglesias, Andres Mauricio Corona, Akshat Sanan, Eduardo Alfonso Perez and Carlos Theodore Huerta
Children 2025, 12(8), 1048; https://doi.org/10.3390/children12081048 - 9 Aug 2025
Cited by 1 | Viewed by 1625
Abstract
Introduction: Indocyanine green (ICG) dye is used in a myriad of medical and surgical applications and complications related to its use are exceedingly rare. ICG fluorescence can be detected in unique locations depending on route, dosage, and timing. Although ICG fluorescence is used [...] Read more.
Introduction: Indocyanine green (ICG) dye is used in a myriad of medical and surgical applications and complications related to its use are exceedingly rare. ICG fluorescence can be detected in unique locations depending on route, dosage, and timing. Although ICG fluorescence is used more commonly in the adult population, its adoption in pediatric surgery has been increasing more frequently. This comprehensive review aims to elucidate the myriad of ICG surgical applications within the pediatric population and important clinical considerations for administration. Methods: PubMed was queried for pediatric surgical applications of indocyanine green. Surgical application, route of administration, dosage, ICG-related complications, and surgical impact of ICG fluorescence were analyzed. Results: In the pediatric population, ICG is used in a multitude of hepatobiliary, gastrointestinal, cardiothoracic, lymphatic, urologic, gynecologic, plastic, ENT, ophthalmologic, and neurosurgical procedures. Applications range from oncologic resections to benign and congenital reconstructions. Administration can be intravenous, intralesional, subcutaneous, inhaled, or enteric. Timing, dosage, and route of administration are dependent on the pathology of interest. Conclusions: ICG is a safe and useful adjunct for a wide variety of pediatric surgical applications. This comprehensive review aims to highlight administration considerations and the efficacy of ICG fluorescence in various surgical subspecialty pathologies. Future studies should continue to focus on how to integrate pathology-specific ICG fluorescence into intraoperative decision-making. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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