Laparoscopic and Computer-Assisted Surgery in Children

Introduction Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. We reviewed the literature on studies published in the last three decades and dealing with advantages and disadvantages of laparoscopy compared to open surgery. Materials and Methods Studies comparing laparoscopic versus open abdominal procedures in children were searched in PubMed/MEDLINE. Reports on upper and lower gastrointestinal as hepatobiliary surgery and on surgery of pancreas and spleen were included. Advantages and disadvantages of laparoscopic surgery were analyzed for different types of procedures. Complications were categorized using the Clavien–Dindo classification. Results A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien–Dindo grade I to III complications (mild–moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency of reporting on advantages after laparoscopy and increased reporting on disadvantages for all surgery types over the decades. Conclusion Laparoscopic compared with open pediatric surgery seems to be beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.

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“…5 Nowadays the techniques may be safely applied in more than 80% of pediatric abdominal operations. 6 7 8…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

et al. 2021

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“…Meanwhile, stress responses in children during surgery are more sensitive than adults. [15] Thus, the present study analyzed the effects of different capnoperitoneum pressures on stress responses, including heart rate (HR), blood pressure, the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) in serum, and aimed to evaluate the suitable capnoperitoneum pressures in pediatric laparoscopic high ligation of the hernia sac.…”

Section: Introductionmentioning

confidence: 99%

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac

Niu

Song²,

Su³

et al. 2017

Medicine

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Background: We aimed to evaluate the effect of different capnoperitoneum pressures on stress responses in pediatric laparoscopic inguinal hernia repair.Methods: In this prospective randomized controlled study, 68 children with indirect inguinal hernia who underwent high ligation of hernia sac were randomly divided into 3 groups: high-pressure group (12 mm Hg, HP group, n = 26); low-pressure group (8 mm Hg, LP group, n = 20); open operation group (OP group, n = 22). Heart rate (HR), blood pressure, and end-tidal CO 2 (PetCO 2 ) were recorded, as well as the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) were measured by ELISAs before operation, during operation, and after operation, respectively.Results: After establishing capnoperitoneum, HR, blood pressure, and PetCO 2 were significantly increased in the HP group compared with the OP and LP groups (P < 0.05). Comparing the intraoperatively measured ACTH and COR concentrations of the HP group to the LP group, we noted higher values in the first (P < 0.05). There was no significant difference in the postoperative concentrations of ACTH and COR among the HP, LP, and OP groups. Abbreviations: ACTH = adrenocorticotropic hormone, ASA = American Society of Anesthesiologists, COR = cortisol, DBP = diastolic blood pressure, ELISA = enzyme-linked immuno sorbent assay, HP = high-pressure, HR = heart rate, LP = low-pressure, OP = open operation, PetCO 2 = end-tidal CO 2 , SBP = systolic blood pressure, SD = standard deviation.

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“…Large series could demonstrate safety and feasibility of various minimally invasive procedures in pediatric surgery. 4 Beyond this, certain benefits of laparoscopy over open appendectomy have been reported for pediatric appendectomy, such as a lower incidence of wound infections and ileus, 5 shorter hospital stay, [6][7][8] and reduced postoperative pain. 6,7,9 Since Semm described the first case of LA, 12 which was done as an incidental procedure during a pelvic exploration almost 30 years ago, different technical aspects of the operation have been further developed.…”

Section: Discussionmentioning

confidence: 99%

“…Prior to that, a right lower quadrant incision was the standard approach for appendectomy. 3 Along with the progress of minimally invasive pediatric surgery in recent years, 4 the laparoscopic approach is now preferred by many pediatric surgeons. 3 Compared with the open approach, it has been shown to reduce the incidence of wound infections and ileus, 5 to shorten the length of hospital stay, [6][7][8] and to reduce postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

Current Status of Laparoscopic Appendectomy in Children: A Nation Wide Survey in Germany

2013

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Laparoscopic and Computer-Assisted Surgery in Children

Cited by 5 publications

References 60 publications

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac

Current Status of Laparoscopic Appendectomy in Children: A Nation Wide Survey in Germany

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