Background/Aim: The objective of the study was to propose clinical guidelines for the use of minimally invasive surgery (MIS) in pediatric oncology. Patients and Methods: Two groups of experts, including pediatric surgeons and pediatric oncologists were created in order to establish strategies of diagnostic and therapeutic surgical management in pediatric oncology. Results: On the basis of the analysis of the existing literature, we elaborated guidelines that were graded according to the simple practical clinical system: yes/no. This project was dedicated to the following topics: adrenal tumors including neuroblastoma, renal tumors including Wilms tumor (nephroblastoma), ovarian tumors and pulmonary nodules and metastases (osteosarcoma). Conclusion: Although existing data do not allow the recommendation of the use of MIS for all indications, this technique should currently be regarded as a standard of care in several areas of pediatric oncology. Minimally invasive surgery (MIS), in contrast to open surgery, is a technique that limits the size of incisions that allow access to peritoneal or thoracic cavities, followed by the use of laparoscope or thoracoscope for visualization and precise dissection. The same target operation should be performed via an open technique or a minimally invasive approach (1-3). The concept of MIS in children with cancer was used for the first time by Holocomb et al. (4), who showed laparoscopy and thoracoscopy to be highly accurate with minimal morbidity for the patient. Both modalities were useful for biopsies, assessment of resectability, staging, evaluation of metastatic or recurrent disease, assessing the potential benefit of second-look procedures, and for diagnosis of infectious complications. The development of this technology has been possible with improved visualization of anatomical structures (5). Subsequent studies and analyses confirmed that MIS procedures in pediatric oncology are safe and effective, resulting in earlier administration of adjuvant therapy. MIS is a developing concept, however in contrast to many areas in adults (6-8), there are no clear guidelines or recommendations in pediatric oncology, mainly due to heterogeneity of clinical diagnoses and small numbers of patients included in the studies. Thus, the aim of this study was to propose clinical guidelines for the use of MIS in pediatric oncology. Guideline Development Overview Two initial groups of experts, including pediatric surgeons and pediatric oncologists were created in order to establish strategies of diagnostic and therapeutic surgical management in pediatric oncology. According to our own experience the relevant issues of MIS utilization in pediatric oncology were defined as follow: adrenal tumors including neuroblastoma (NBL), renal tumors including Wilms tumor (WT), ovarian tumors, pulmonary nodules and metastases. The main desired outcome was evidence of a reduction in open surgery, and secondary outcomes included efficacy and safety, expressed as rate of complications. We performed Pub Med sea...