Minimally invasive surgery in infants and children

Abstract

The evolution of minimally invasive surgical techniques for adults has been among the most important surgical developments of the last century. Much of the morbidity, stress, and pain of an operation are due to the trauma of the access wound. By decreasing the size of the incision, the postoperative morbidity and pain should be diminished. The potential advantages of minimally invasive surgery (MIS) have been documented in many adult and animal studies. The application of minimally invasive techniques to infants and children has advanced more slowly than in adults. This delay in development has multiple causes. Surgical instruments developed for adults are cumbersome and less safe when used in infants and children. No single procedure propelled the evolution of MIS in neonates like laparoscopic cholecystomy in adults. Medical practitioners have frequently underestimated the importance of pain and stress caused by surgical incisions in children who are less able to articulate their distress. The absolute length of an open surgical incision in a neonate is short and thought to be less traumatic. However, these incisions are proportionally as long as incisions for similar surgical procedures in adults. Due to the small size of neonates and young children, the intracavitary working space for endoscopic procedures is small, making procedures in this age group more technically difficult. Development of smaller instruments and documentation of the safety of endoscopic techniques have allowed pediatric surgeons to apply thoracoscopy and laparoscopy to infants and children. Over the last 15 years, there has been a virtual explosion in neonatal minimally invasive surgical procedures. This chapter will outline the current procedures commonly performed endoscopically in children. With the evolution of constantly improving surgical instruments and alternative devices for anastomosis, pediatric endoscopic surgery should continue to grow at a rapid pace. © 2009 Springer Berlin Heidelberg.