Advances and Trends in Pediatric Minimally Invasive Surgery

Abstract

As many meta-analyses comparing pediatric minimally invasive to open surgery can be found in the literature, the aim of this review is to summarize the current state of minimally invasive pediatric surgery and specifically focus on the trends and developments which we expect in the upcoming years. Print and electronic databases were systematically searched for specific keywords, and cross-link searches with references found in the literature were added. Full-text articles were obtained, and eligibility criteria were applied independently. Pediatric minimally invasive surgery is a wide field, ranging from minimally invasive fetal surgery over microlaparoscopy in newborns to robotic surgery in adolescents. New techniques and devices, like natural orifice transluminal endoscopic surgery (NOTES), single-incision and endoscopic surgery, as well as the artificial uterus as a backup for surgery in preterm fetuses, all contribute to the development of less invasive procedures for children. In spite of all promising technical developments which will definitely change the way pediatric surgeons will perform minimally invasive procedures in the upcoming years, one must bear in mind that only hard data of prospective randomized controlled and double-blind trials can validate whether these techniques and devices really improve the surgical outcome of our patients.

Robotically Assisted Surgery in Children—A Perspective

“…Considering innovation and technology development, augmented reality (AR) and augmented intelligence might represent the next steps in RAS [ 1 ]. AR refers to a mixture of virtual reality and the physical world, where computer-generated input is interposed into the real world [ 57 ].…”

“…The introduction of robotically assisted surgery (RAS) was a milestone for minimally invasive surgery in the 21st century. Previously, laparoscopic approaches (LA) represented the first step away from open surgery arising from new technical innovations [ 1 ]. In 2000, the da Vinci ® surgery system (Intuitive Surgical, Sunnyvale, CA, USA) revolutionized the industry by applying principles that were similar to those of LA but that used remotely controlled instruments [ 2 ].…”

Paediatric robotic surgery: a narrative review

“…This in turn led to rapid advancements in complexity of surgery performed by MIS as expertise and skillset evolved with increasing volume and comfort, with complex major surgery by MIS now being the gold standard in adult patients [3,4]. In contrast to this, utilisation of MIS in the paediatric community has progressed at a much slower rate [5,6]. A significant barrier for paediatric MIS has been the technical challenge posed by laparoscopic surgery in small working spaces, where clashing of instruments and restrictive working angles may act as a barrier to safe dissection [5][6][7].…”

“…In contrast to this, utilisation of MIS in the paediatric community has progressed at a much slower rate [5,6]. A significant barrier for paediatric MIS has been the technical challenge posed by laparoscopic surgery in small working spaces, where clashing of instruments and restrictive working angles may act as a barrier to safe dissection [5][6][7]. Thus, open surgery remains relatively commonplace in paediatrics, with significant debate existing over utilisation of laparoscopy even in index operations such as appendicectomy or inguinal hernia repair [5][6][7].…”

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

“…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 ].…”