BACKGROUND: Primary cause of extrinsic ureteropelvic junction obstruction is the crossing of accessory renal pole vessels. Vascular hitch (VH) is a safe and efficient procedure. The study aimed to analyze its long-term o...BACKGROUND: Primary cause of extrinsic ureteropelvic junction obstruction is the crossing of accessory renal pole vessels. Vascular hitch (VH) is a safe and efficient procedure. The study aimed to analyze its long-term outcomes for renal perfusion and function. METHODS: This retrospective study included children who underwent a VH at our institute between 2006 and 2021. Further surgeries on the same kidney were an exclusion criterion. The minimum follow-up period was 2 years. Data about symptoms, blood tests, blood pressure measurement, and renal ultrasound (US) with colour Doppler was collected at long term follow-up. RESULTS: Fifty-nine patients were included, of whom 24 consented to taking part in the study and completed all the required examinations. The median follow-up period was 8.4 years (range 2.2-15.8). Two patients (8 %) experienced recurrence of symptoms in form of urinary tract infections. Two cases (8 %) presented with hypertension, without renovascular characteristics. Blood tests showed normal renal function in all patients. Renal US showed an improvement or normalisation of the anterior-posterior pelvic diameter in all patients. Three patients (13 %) presented renal hypotrophy, already known preoperatively. Colour Doppler was normal in all patients, with median RI of 0.58 (range 0.42-0.70). CONCLUSION: Long-term follow-up showed that VH is a feasible and safe technique for treating extrinsic ureteropelvic junction obstruction treatment in terms of preserving renal perfusion, as the cranial displacement of the inferior polar vessels does not alter this. In our sample, the surgical procedure did not affect renal function, arterial blood pressure, or renal colour Doppler ultrasound findings.
van Streun SP, Roorda D, van der Steeg AFW
… +5 more, Gorter RR, Derikx JPM, van Heurn LWE, Oosterlaan J, Emma Children's Hospital Amsterdam UMC Follow-Me program consortium
INTRODUCTION: Congenital malformations requiring surgery are rare conditions, and despite decreasing mortality, these conditions are associated with substantial morbidity. Although research on outcomes of these patients...INTRODUCTION: Congenital malformations requiring surgery are rare conditions, and despite decreasing mortality, these conditions are associated with substantial morbidity. Although research on outcomes of these patients is mostly focused on short term somatic outcomes, emerging evidence suggests morbidity in other aspects of functioning, such as neurodevelopmental impairment and impaired psychosocial functioning. Therefore, prospective multidisciplinary follow-up is important. Moreover, standardizing follow-up creates the opportunity to use data collected in follow-up for routine outcome monitoring aimed at healthcare evaluation and improvement of patient outcome, and for scientific research. METHODS: In this paper the design of a standardized prospective multidisciplinary follow-up program of surgical congenital malformations in the Amsterdam University Medical Center (Amsterdam, the Netherlands) is presented. Development of follow-up protocols, the composition of the multidisciplinary team, the process of data collection, implemented patient-reported and clinician reported outcome measures, the practical design of the follow-up carousel and multidisciplinary team meeting, and the healthcare evaluation sessions that are implemented in the program are described. Furthermore, we describe the data-driven approach to improvement of healthcare quality and patient outcome, that is integrated in this program. DISCUSSION: Prospective multidisciplinary follow-up in patients with surgical congenital malformations offers the possibility to standardize outcome measurements including patient-reported outcomes, thus allowing for 1) early recognition and intervention for poor outcome, thus improving patient outcome, 2) improvement of quality of healthcare by conducting outcome evaluation, and 3) a contribution to research on outcome and prognosis of patients with surgical congenital malformations.
PURPOSE: No Urethroplasty Techniques (NUTs) are technically simple, low-morbidity alternatives to urethroplasty for the correction of distal hypospadias. Along with functional outcomes, cosmetic results have become incre...PURPOSE: No Urethroplasty Techniques (NUTs) are technically simple, low-morbidity alternatives to urethroplasty for the correction of distal hypospadias. Along with functional outcomes, cosmetic results have become increasingly relevant in recent years. Despite the high number of techniques, some drawbacks remain in achieving these goals. The aim of this paper is to describe the Inverted V-I MeatoGlanuloplasty technique, developed at our center for the treatment of distal hypospadias and to evaluate its outcomes. MATERIALS AD METHODS: A retrospective, single-center study was conducted on patients with distal hypospadias treated with Inverted V-I MeatoGlanuloplasty between 2005 and 2024. The technique involves a triangular skin flap excision under the meatal apex, deep glanular dissection, meatoplasty, and glanuloplasty. Data on demographics, type of hypospadias, surgical details, complications, and follow-up were collected. RESULTS: During the study period, a total of 190 procedures were performed at a median age of 3.0 (1.2-17.2) years. Patients presented with 97 (51.1 %) glanular, 84 (44.2 %) coronal, and 9 (4.7 %) distal penile hypospadias. Chordee was present in 122/190 (64.2 %) patients and was corrected with spongioplasty. Complications were observed in 9 patients (4.7 %): 5 meatal retractions (2.6 %) and 4 fistulas (2.1 %). No infections or meatal stenoses occurred. Aesthetic and functional outcomes were satisfactory in most patients. CONCLUSIONS: The IV-IMG technique is a well reproducible procedure that offers excellent functional and cosmetic outcomes in distal hypospadias, with a low complication rate. It represents a valid alternative to other non-urethroplasty techniques when glans anatomy and meatal position are favorable.
BACKGROUND: Pectus deformities, including pectus excavatum, are associated with psychosocial burden and in severe cases impaired cardiorespiratory function. Minimally invasive repair of pectus excavatum (MIRPE) is the st...BACKGROUND: Pectus deformities, including pectus excavatum, are associated with psychosocial burden and in severe cases impaired cardiorespiratory function. Minimally invasive repair of pectus excavatum (MIRPE) is the standard corrective surgery; however, the postoperative pain can be significant. Patients' perioperative anxiety can be severe as they are cognitively aware of the awaiting surgical challenges but often lack effective coping strategies. Virtual reality (VR) is a non-invasive, non-pharmacological modality that has shown promise in reducing anxiety and modulate pain in the pediatric population. This study aimed to evaluate the effect of VR as a distraction tool in decreasing anxiety and pain associated with MIRPE. METHODS: In this single-center, randomized-controlled study, 50 patients aged 13-18 were enrolled in 2022-2024. Patients were scheduled for elective surgery with general anesthesia and were randomly allocated to VR (n = 25) or control (n = 25) group. State-Trait Anxiety Inventory (STAI) tests were recorded upon admission to the hospital, on arrival at the operating room and in the morning after the surgery, complemented with emergence delirium and pain assessment tests, when appropriate. All patients received midazolam as premedication. Patients assigned to the VR group received a VR headset and underwent audiovisual distraction for an hour before the surgery. The main outcome was the STAI-S score in the operating room. Data is in median [IQR]. RESULTS: Median patient age was 15.6 and 82 % were male. No difference was found between the STAI-S scores between the two groups on admission (37 [32.5, 47] and 41 [35; 47]); in the operating room (39 [32.5, 47] and 42.5 [35; 48.3]); and in the postoperative morning (37 [32, 42] and 39 [35, 45], respectively). Multiple regression revealed that STAI-S at admission and patients' age are significantly associated with anxiety levels in the OR (p= <0.001, p = 0.039). Points on the emergence delirium score, and postoperative numerical rating scale for pain were similar in the two groups apart from 1 h postoperative, which was significantly lower in the VR group (p = 0.012). CONCLUSION: Although VR was proven useful in anxiolysis in previous papers in the pediatric setting, this study could not detect a change in anxiety with the use of VR in the perioperative period of MIRPE in adolescents. It is conceivable that the midazolam administered as premedication neutralized the effect of VR. CLINICAL TRIAL NUMBER: NCT06446518.
INTRODUCTION: The aim of this study was to evaluate colonic motility and anatomy in children treated with antegrade continence enema (ACE), utilizing colonic manometry (CM) and contrast enema (CE) studies. METHODS: A ret...INTRODUCTION: The aim of this study was to evaluate colonic motility and anatomy in children treated with antegrade continence enema (ACE), utilizing colonic manometry (CM) and contrast enema (CE) studies. METHODS: A retrospective review of patients treated surgically with ACE who underwent CM. Patient demographics, medical and surgical history, clinical symptoms, CM results, and CE results were recorded. RESULTS: Seventy patients (59 % female, median age at time of CM of 10 years) with CM after starting ACE treatment were included, 74 % had a diagnosis of functional constipation. CM after ACE showed normal motility in 43 %, distal colonic dysmotility in 29 %, total colonic dysmotility in 21 %, and proximal colonic dysmotility in 6 %. In the children with CEs before and after starting ACE treatment (n = 25), 20 % developed proximal colonic dilation after ACE. These patients had a longer median duration of ACE treatment compared to those who did not have proximal colonic dilation (41 vs 16 months, p = 0.062). Flush volume and contents, response to flush, proximal colonic dysmotility, and underlying diagnosis did not differ between those who did and did not develop proximal colonic dilation after ACE. CONCLUSION: In patients treated with ACE, proximal colonic dysmotility was only seen in 6 %. Development of proximal colonic dilation was seen in 20 % of patients, with a longer duration of treatment potentially contributing to its occurrence. Future studies are needed to understand the impact of this anatomy change and translate our findings into best practice for management of these children.
OBJECTIVE: This study aimed to present our experience in applying robotic-assisted surgery for managing pancreatic disorders in children. METHODS: A retrospective analysis was conducted on pediatric patients who underwen...OBJECTIVE: This study aimed to present our experience in applying robotic-assisted surgery for managing pancreatic disorders in children. METHODS: A retrospective analysis was conducted on pediatric patients who underwent robot-assisted pancreatic procedures at two centers from April 2020 to August 2025. Information regarding preoperative status, intraoperative details, and postoperative outcomes was collected. RESULTS: A total of 49 pediatric patients received pancreatic surgery during the study period, including 19 boys and 30 girls, with a mean age of 10.3 ± 2.6 years. Surgical indications were pancreatic masses (n = 46), pancreatic trauma (n = 2), and congenital hyperinsulinism (n = 1). The mean operation time was 233.4 ± 117.3 min, and average blood loss was 59.4 ± 81.9 ml. Six patients (12.2 %) converted to open surgery. The total complication rate was 38.8 % (19/49), with major complications (Clavien-Dindo ≥ III) in 6.1 % (3/49). Postoperative pancreatic fistula (POPF) occurred in 7 patients (14.3 %), all of which were Grade B; two of these patients required ultrasound-guided external drainage. Two patients were readmitted within 30 days for intra-abdominal infection. The median follow-up was 23.4 months (range 3-62 months), and all remained alive without complications. CONCLUSION: Robot-assisted surgery for pediatric pancreatic disorders appears to be safe and feasible. The robotic platform can be employed for various complex pancreatic operations with satisfactory results.
BACKGROUND: Restorative Proctocolectomy (RP) with Ileal Pouch-Anal Anastomosis (IPAA) represents the gold-standard surgical treatment for patients requiring total colonic and rectal removal due to ulcerative colitis, fam...BACKGROUND: Restorative Proctocolectomy (RP) with Ileal Pouch-Anal Anastomosis (IPAA) represents the gold-standard surgical treatment for patients requiring total colonic and rectal removal due to ulcerative colitis, familial adenomatous polyposis, and other colonic pathologies. The laparoscopic approach (L-IPAA) has been increasingly utilized in pediatric and young adult populations to enhance recovery and reduce morbidity; however, its benefits over open surgery (O-IPAA) remain uncertain. This meta-analysis aimed to compare outcomes between L-IPAA and O-IPAA, focusing on complications, operative time, and length of hospital stay (LOS). METHODS: A systematic review and meta-analysis were performed according to PRISMA guidelines, including comparative studies of patients <21 years undergoing IPAA. Databases searched included PubMed, Ovid, and Cochrane CENTRAL up to September 2025. Primary outcomes were major intra- and post-operative complications; secondary outcomes included minor complications, operative time, and LOS. Data were analyzed using random-effects models, with risk of bias assessed via ROBINS-I and evidence quality graded using the GRADE system. RESULTS: Eight studies encompassing 1094 patients met inclusion criteria: 412 underwent O-IPAA and 682 underwent L-IPAA. No significant differences were found in major intra-operative (OR = 0.871, p = 0.888) or major post-operative complications (OR = 0.798, p = 0.599). L-IPAA showed a trend toward fewer minor complications (OR = 0.514, p = 0.071) and demonstrated a significantly shorter hospital stay (OR = 0.480, p < 0.001). Operative time was significantly longer in the laparoscopic group (OR = 1.784, p < 0.001). Heterogeneity across studies was moderate to high, and the overall certainty of evidence ranged from very low to moderate. CONCLUSION: Both laparoscopic and open IPAA are safe and effective for pediatric and young adult patients requiring total proctocolectomy. While laparoscopic surgery entails a longer operative time, it offers a clear benefit in reducing hospital stay, with comparable complication rates. Further multicenter randomized studies are needed to validate these findings and define the optimal surgical approach.
PURPOSE: This study analyzed the effect of pulmonary metastatic burden at diagnosis and response to chemotherapy on disease-free and overall survival in patients with hepatoblastoma (HB), hypothesizing that long-term sur...PURPOSE: This study analyzed the effect of pulmonary metastatic burden at diagnosis and response to chemotherapy on disease-free and overall survival in patients with hepatoblastoma (HB), hypothesizing that long-term survival can be achieved in the setting of extensive pulmonary metastatic disease requiring metastasectomy. METHODS: An analysis of a multicenter dataset including children with HB and pulmonary metastatic disease at diagnosis was performed. Patients who presented with >10 pulmonary metastases were defined as having extensive metastatic disease. Kaplan Meier and univariate Cox Proportional Hazards analyses assessed disease-free survival (DFS) and overall survival (OS), analyzing the effect of pulmonary metastatic disease extent and modality of clearance. RESULTS: Among 315 patients with HB, pulmonary metastatic disease at diagnosis (n = 62) was associated with poorer DFS and OS (both p > 0.05). Of patients with pulmonary metastases, 23 (37 %) had extensive disease. Clearance of metastases occurred in 59 (95 %) patients: 32 (54 %) with chemotherapy alone and 27 (46 %) with chemotherapy and metastasectomy. Survival was similar between patients with >10 vs. ≤10 lung metastases and between those who had clearance of lung metastases by chemotherapy alone vs. chemotherapy and metastasectomy (all p > 0.05). Among 16 patients who required liver transplantation, all patients who underwent surgical clearance of metastatic disease were alive at last follow-up. CONCLUSION: Among patients with HB who had pulmonary metastatic disease at diagnosis, long-term survival is possible regardless of the extent of pulmonary disease. A combination of neoadjuvant chemotherapy and metastasectomy can be utilized to achieve lung clearance.
INTRODUCTION: Skip lesion aganglionosis is characterized by intestinal aganglionosis interrupted by portions of normally ganglionated bowel that is located in between segments of aganglionosis. Even though this is a well...INTRODUCTION: Skip lesion aganglionosis is characterized by intestinal aganglionosis interrupted by portions of normally ganglionated bowel that is located in between segments of aganglionosis. Even though this is a well-known entity, only scattered cases have been reported so far. The aim of this manuscript is to present our series of patients and perform a systematic literature review, to offer a critical overview of possible management. PATIENTS AND METHODS: We hereby present a case series of 4 patients diagnosed during the last five years in our Centre in accordance to SCARE guidelines. A systematic review according to PRISMA guidelines was performed to better address this extremely rare surgical dilemma. RESULTS: Our case-series included only patients with ultralong Hirschsprung, being 3 Total Colonic Aganglionosis and 1 Extended Aganglionosis. Detailed description of each case is reported. Systematic Literature Review included ended up with a total of 50 patients mostly suffering from ultralong Hirschsprung and whose diagnostic pathway proved to be heterogenous with diagnostic delays and misdiagnoses. DISCUSSION: Based on this case series and on literature data, skip lesion aganglionosis should be referred to highly experienced referral centers and deserve a dedicated diagnostic and therapeutic management. The motility of ganglionated bowel distal to skip lesions proved to be impaired in our experience thus suggesting avoiding the use of this non-functioning bowel to restore continuity. The Authors propose a detailed algorithm to reduce misdiagnoses and avoid dangerous delays.
INTRODUCTION: Surgical correction of adolescent idiopathic scoliosis (AIS) has traditionally relied on posterior spinal fusion (PSF). However anterior vertebral body tethering (VBT) has offered a motion-preserving altern...INTRODUCTION: Surgical correction of adolescent idiopathic scoliosis (AIS) has traditionally relied on posterior spinal fusion (PSF). However anterior vertebral body tethering (VBT) has offered a motion-preserving alternative that maintains spinal flexibility. This study describes our institutions' mini-open thoracoscopically assisted anterior (MOTA) approach and outcomes for anterior spinal VBT exposure. METHODS: 344 patients with AIS treated with anterior VBT between February 2016 and July 2024 were reviewed. Operative data included type of approach, instrumented spinal levels, rib resection, operative time, and EBL. Outcomes data included LOS, chest tube duration, foley, epidural placement, and 30-day complications. Data was analyzed using ANOVA, chi-squared, and Tukey Honestly Significant Difference. Aggregate results were compared with literature outcomes of VBT and PSF. RESULTS: Double curve cases were found to have longer operative times, increased EBL, longer LOS, and longer duration of epidural and foley compared to other approaches but also had the greatest number of instrumented spinal levels. In aggregate, we found our MOTA approaches to have significantly shorter operative times (182.54 min) than literature VBT (327.93) while still having comparable EBL (155.8 cc), length of stay (5.42 days) and postoperative opioid use (3.4 days) when compared with literature VBT outcomes. DISCUSSION: Our institution has found success in the management of AIS with MOTA thoracic and thoracolumbar spinal exposures. We caution that providers must have thorough understanding of the surgical anatomy and dissection technique prior to offering this correction approach.
BACKGROUND: The management of pediatric abdominal-dominant polytrauma, where life-threatening abdominal injuries coexist with other system injuries, lacks a standardized, surgery-led decision-making framework. This study...BACKGROUND: The management of pediatric abdominal-dominant polytrauma, where life-threatening abdominal injuries coexist with other system injuries, lacks a standardized, surgery-led decision-making framework. This study aimed to evaluate the evolution and impact of a structured "Abdomen-First" Multidisciplinary Trauma Protocol (AF-MTP) developed at a high-volume pediatric trauma center. METHODS: A retrospective cohort study was conducted on children (age <16 years) with severe polytrauma (Injury Severity Score ≥25) and major abdominal injuries (Abbreviated Injury Scale ≥3) admitted between 2014 and 2023. Patients were stratified into three epochs reflecting system evolution: Traditional Care (2014-2016), Protocol Transition (2017-2020), and Integrated Maturation (2021-2023). The AF-MTP featured general surgery-led team activation, a "one-stop" whole-body CT strategy, a defined decision algorithm prioritizing abdominal intervention, objective damage control surgery (DCS) criteria, and a standardized postoperative care bundle. Process metrics and clinical outcomes were compared across epochs. RESULTS: Among 120 included patients, injury severity increased significantly across epochs (median ISS: 30 vs. 36 vs. 41, p < 0.001). Concurrently, AF-MTP implementation was associated with marked improvements: time from emergency department arrival to surgical incision decreased by 52 % (130 vs. 62 min, p < 0.001), DCS application increased from 22.5 % to 85.0 % (p < 0.001), and non-therapeutic laparotomy decreased from 17.5 % to 2.5 % (p = 0.036). Despite higher injury burden, abdominal injury-related 30-day mortality decreased by 75 % (20.0 %-5.0 %, p = 0.045 for trend). Multivariable analysis confirmed treatment in the mature protocol epoch (Epoch III) as an independent protective factor against abdominal-related mortality (aOR 0.18, 95 % CI 0.03-0.95). CONCLUSION: The systematic implementation of a general surgery-led, protocol-driven "Abdomen-First" multidisciplinary system significantly improved the efficiency of care and survival for children with severe abdominal-dominant polytrauma, even as injury complexity increased. This model provides a replicable framework for optimizing trauma resuscitation where abdominal injury is the primary physiological threat.
BACKGROUND: Superficial second-degree burns pose major clinical challenges, including extended healing time duration, infection risk, and patient discomfort. Although advanced synthetic dressings such as self-adhesive si...BACKGROUND: Superficial second-degree burns pose major clinical challenges, including extended healing time duration, infection risk, and patient discomfort. Although advanced synthetic dressings such as self-adhesive silicone foam (Mepilex®XT) improve outcomes, novel interventions require evaluation. This study compares efficacy and safety between a novel subvacuum dressing and Mepilex®XT in managing superficial second-degree burns in children. The aim of this study was to investigate whether the novel subvacuum dressing for superficial second-degree burns is non-inferior to Mepilex®XT. METHODS: This prospective, randomized, controlled multicenter non-inferiority trial enrolled 82 participants aged 2-14 years with superficial second-degree burns. Patients were randomly assigned to the experimental (novel subvacuum dressing) or control (Mepilex®XT) groups. A total of 78 participants completed the study, comprising 41 in the experimental group and 37 in the control group. The primary outcome was time to complete wound closure via standardized assessment. Secondary outcomes included infection rates and adverse reactions. Baseline comparability was assessed for patient demographics, burn size, and anatomical location. RESULTS: No significant intergroup differences were observed in baseline characteristics (all P > 0.05). Time to complete wound closure was comparable between groups (P > 0.05). Safety profiles were similar, with no significant differences in adverse event frequency or severity (P > 0.05). Experimental dressing and standard care results demonstrated no significant differences across all metrics. CONCLUSIONS: The novel subvacuum dressing demonstrated comparable efficacy and safety to Mepilex®XT, proving beneficial in promoting healing of superficial second-degree burns in pediatric patients.
BACKGROUND: Retractile testes have long been considered a normal variant, yet emerging evidence questions this assumption. Given the central role of the cremaster muscle in testicular position, this study aimed to compar...BACKGROUND: Retractile testes have long been considered a normal variant, yet emerging evidence questions this assumption. Given the central role of the cremaster muscle in testicular position, this study aimed to compare the histological and immunohistochemical characteristics of the human cremaster muscle in boys with retractile testes (RT) and undescended testes (UDT), using patients with inguinal hernia (IH) and normally descended testes as controls. METHODS: Forty boys undergoing surgery between March 2021 and April 2023 were enrolled: 22 with retractile testis, 7 with congenital cryptorchidism, and 11 controls with inguinal hernia. Intraoperative biopsies of the cremaster muscle were evaluated using hematoxylin-eosin staining and digital morphometry. Immunohistochemistry for myosin heavy chain (MyHC)-embryonic and antibody CD34 was performed. Statistical analysis assessed differences in muscle fiber diameters, morphology, MyHC-embryonic expression, and intramuscular capillary density among groups and across age subgroups. RESULTS: Retractile and undescended testes demonstrated similar muscle fiber morphology, characterized by significantly smaller minimum and maximum muscle fiber diameters compared with controls (p < 0.001). Atrophic fibers were frequent in retractile testes (16/22), less common in cryptorchidism (2/7), and absent in controls. Both the retractile testis and the UDT group exhibited significantly higher MyHC-embryonic expression than controls (p = 0.038 and p = 0.0016 respectively). CD34 staining revealed markedly increased intrafascicular capillary density in retractile testes compared with both other groups (p < 0.001). CONCLUSIONS: Cremaster muscle in retractile testes demonstrates histological and immunohistochemical patterns closely resembling congenital cryptorchidism - a clearly defined pathological condition-rather than normal controls. At the same time, findings suggest that the retractile testis is a distinct clinical entity, with probable ongoing muscle remodeling and possible regenerative activity, rather than a physiological variant. These results combined advocate for closer monitoring of the young patients with clinical re-evaluations, while raising the question of whether earlier surgical intervention prior to puberty warrant further investigation.
INTRODUCTION: Surgery for neuroblastic tumours can entail difficult decisions about what and where to resect. Indocyanine Green(ICG) near-infrared fluorescence(NIRF) may help with decisions about resecting disease where...INTRODUCTION: Surgery for neuroblastic tumours can entail difficult decisions about what and where to resect. Indocyanine Green(ICG) near-infrared fluorescence(NIRF) may help with decisions about resecting disease where critical structures are at risk of injury or where a total resection would cause life changing disability. We reviewed the results for all children undergoing ICG NIRF guided surgery for neuroblastic tumours in our centre. MATERIALS AND METHODS: Review of single quaternary centre patients between 01/2019 and 12/2023 with a neuroblastic tumour undergoing surgical biopsy or resection with ICG NIRF. Demographics, imaging, tumour details, ICG dosing, intra-operative findings, pathology reports and follow up were reviewed. RESULTS: Twelve patients(6F) underwent 17 surgical procedures (12 resections and 5 biopsies). Six patients were stage L1, four patients L2 and two patients had metastatic disease. Eight patients had neuroblastoma (NBL), 2 ganglioneuroma (GN), and 1 ganglioneuroblastoma (GNBL). One case had mixed biology with multiple foci of NBL and GN. Aflourescence/hypofluorescence occurred in 8 patients with GN, GNBL or <10 % viable NBL. Hyperfluorescence was seen in three patients with primitive neuroblasts confirmed on pathology. In the patient with mixed biology, ICG NIRF showed hyperfluorescent areas (containing primitive neuroblasts) and afluorescent ones (containing GN). Following chemotherapy, all disease was afluorescent. In the fluorescent NBL lesions, NIR microscopy showed a median (IQR) tumour to background ratio (TBR) of 5.385 (4.2):1. CONCLUSION: The results of this preliminary small cohort suggest that ICG NIRF can predict the presence of primitive neuroblastic tissue and be a useful adjunct to surgical decision making.