Thirty Years of Minimally Invasive Surgery in Children: Analysis of Meta-Analyses

Abstract

Introduction In the last three decades, minimally invasive surgery (MIS) has been widely used in pediatric surgery. Meta-analyses (MAs) showed that studies comparing minimally invasive with the corresponding open operations are available only for selected procedures. We evaluated all available MAs comparing MIS with the corresponding open procedure in pediatric surgery. Materials and Methods A literature search was performed on all MAs listed on PubMed. All analyses published in English, comparing pediatric minimally invasive with the corresponding open procedures, were included. End points were advantages and disadvantages of MIS. Results of 43 manuscripts were included. MAs evaluating the minimally invasive with the corresponding open procedures were available for 11 visceral, 4 urologic, and 3 thoracoscopic types of procedures. Studies included 34 randomized controlled trials. In 77% of MAs, at least one advantage of MIS was identified. The most common advantages of MIS were a shorter hospital stay in 20, a shorter time to feeding in 11, and a lower complication rate in 7 MAs. In 53% of MAs, at least one disadvantage of MIS was found. The most common disadvantages were longer operation duration in 16, a higher recurrence rate of diaphragmatic hernia in 4, and gastroesophageal reflux in 2 MAs. A lower native liver survival rate after laparoscopic Kasai-portoenterostomy was reported in one MA. Conclusion In the available MAs, the advantages of MIS seem to outnumber the disadvantages. However, for some types of procedures, MIS may have considerable disadvantages. More randomized controlled trials are required to confirm the advantage of MIS for most procedures.

Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence

“…10 In a recent review of MAs, the benefits of minimally invasive surgery have clearly been shown for several types of laparoscopic procedures in children. 70 However, corresponding analyses for thoracoscopic procedures were lacking. The few MAs concerning VATS were based on a limited VATS was associated with more than 15 different advantages and in more than half of the studies no disadvantage was mentioned.…”

Minimally Invasive Pediatric Surgery: The Learning Curve

“…1,2 MIS offers several well-established advantages when compared with open surgery, such as faster recovery time, lower complication rates, and better cosmesis. 3,4 However, advanced surgical skills are needed to be able to perform the technically demanding procedures in small working spaces.…”

Advances and Trends in Pediatric Minimally Invasive Surgery

“…Data of meta-analyses were presented for several other pediatric surgical conditions in a recent report [2]. Although relying on nonblinded trials, the authors concluded that the advantages of minimally invasive surgery (mainly time to enteral feedings and hospital stay) seem to outnumber the disadvantages, such as procedure specific complications.…”

“…Most analyses focus on soft outcome parameters of minimally invasive surgery, such as time to enteral feedings, time to full mobilization, duration of hospital stay, cosmetics of the wounds and quality of life, which often result in favor of minimally invasive surgery, partially because of the abovementioned bias [2]. Solid outcome parameters, such as intraoperative and postoperative complication rates as well as long term sequelae of the procedures are often just as reported as byproducts.…”

“…Minimally invasive pediatric surgery has developed rapidly in the last 30 years extending from fetuses to 17 year old overweight adolescents. As many meta analyses and analyses of meta analyses comparing minimally invasive surgery to open procedures can be found in the recent literature, this review focuses on the current trends and advances which already have or may have an impact on pediatric minimally invasive surgery [1,2].…”