Pediatric Minimally Invasive Surgery: Laparoscopy and Thoracoscopy in Infants and Children

Abstract

This article discusses the potential benefits and challenges of minimally invasive surgery for infants and small children, and discusses why pediatric minimally invasive surgery is not yet the surgical default or standard of care. Minimally invasive methods offer advantages such as smaller incisions, decreased risk of infection, greater surgical precision, decreased cost of care, reduced length of stay, and better clinical information. But none of these benefits comes without cost, and these costs, both monetary and risk-based, rise disproportionately with the declining size of the patient. In this review, we describe recent progress in minimally invasive surgery for infants and children. The evidence for the large benefits to the patient will be presented, as well as the considerable, sometimes surprising, mechanical and physiological challenges surgeons must manage.

Minimal Access Surgery in Neonates

“…The pediatric and neonatal instruments are further modified in an effort to be able work inside chest and abdomen of the tiny kids [2].…”

“…MIS has gradually been accepted as a treatment modality for neonatal surgical conditions. In the hands of experienced surgeons, MIS has the added advantages of reduced tissue trauma, decreased pain medication, reduced hospital stay and better clinical information [1][2][3]. But these benefits of MIS do not come without costs, being both monetary and riskbased; and these risks rise disproportionately with the decreasing size of the patients, understandably, the neonates are most vulnerable.…”

“…But these benefits of MIS do not come without costs, being both monetary and riskbased; and these risks rise disproportionately with the decreasing size of the patients, understandably, the neonates are most vulnerable. The surgeons have to face a daunting challenge, both mechanical and physiological in the management of neonatal surgical conditions [2][3][4]. Historically, pediatric surgeons have reservations to accept MIS as the standard of surgical care.…”

“…Historically, pediatric surgeons have reservations to accept MIS as the standard of surgical care. The reasons being factors related to physiology, anatomy, anesthesia, technical and logistic simultaneously [2,4]. A recent study involving pediatric surgeons from around the world has shown the skepticism among the pediatric surgeons about performing MIS for neonatal conditions.…”

Endosurgery in Diagnosis of Tumor Diseases in Children

“…Тем самым сроки реабилитации становятся значительно короче, чем после открытых оперативных вмешательств. Как преимущество хирурги отмечают косметический эффект, что важно для детей [24].…”