Laparoscopy in infants and children: A prospective study on feasibility and the impact on routine surgery

Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies

“…This is considerably higher than the reported conversion rate of less than 10% in patients with nonmalignant conditions. 2,21,22 In recent years, minimally invasive techniques have been widely used to establish a diagnosis, for staging purposes, and for evaluation of recurrent or metastatic disease in children. 3,4,23 The spectrum of malignancies included the whole range of pediatric abdominal, retroperitoneal, and thoracic tumors, such as neuroblastoma, nephroblastoma, hepatoblastoma, rhabdomyosarcoma, teratoma, lymphoma, and numerous others.…”

“…1,2 The postulated advantages are an overall decrease in pain and need for postoperative narcotics, decreased morbidity, shorter hospital stay, and better cosmesis. Since Holcomb et al 3 reported on a first series of children with cancer undergoing biopsy in 1995, an increasing number of authors confirmed an excellent safety and accuracy of minimally invasive techniques for establishing the diagnosis in children with suspected malignancy.…”

Laparoscopy in Children and Infants

“…In addition, operating room staff may not be fully aware of alternative instruments which may be required intra-operatively to deal with challenges or conditions that were not apparent before the start of the procedure. Ure et al (2000) noted that problems with instruments and devices led to a mean time loss of 15.1 minutes in 15.6% of the laparoscopic procedures in their series. The rate of conversion is related to the complexity of the procedure as indicated by target organ position in the abdominal cavity, adherence to neighbouring or surrounding structures, malignant tendency, inflammation, presence of pus or peritoneal soiling, presence of adhesions between the abdominal wall and intra-abdominal structures as well as surgeon's expertise.…”

Minimal access surgery in adolescent gynaecology

“…5,6 Many of the considerations and risks that are taken into account when deciding to operate on an adult play a very important role in planning surgery on an adolescent. Laparoscopy is generally contraindicated in haemodynamically unstable patients or in those with known severe abdominal adhesions secondary to previous open surgery.…”

“…Younger children may require lower pressure setting at 8-12 mmHg. 6 Additional ports must be placed under direct vision so as to avoid injury to viscera or vessels. Ports should be placed either very lateral or medial so as to avoid the inferior epigastric vessels.…”