Pediatric Laparoscopy

Abstract

Significant developments in minimally invasive surgery (MIS) for the adult population have led to increased application of MIS techniques for pediatric patients. Laparoscopy is the most common MIS procedure used in pediatrics. Traditional surgical procedures that are now being performed laparoscopically include gastrostomy, pyloromyotomy, and repair of congenital diaphragmatic hernia and imperforate anus. All perioperative team members must be prepared to provide appropriately sized instruments and equipment to facilitate use of MIS techniques in the pediatric population and must ensure safe patient care to achieve optimal patient outcomes.

Laparoscopic nephrectomy for Wilms’ tumor

“…Minimally invasive surgery, when properly performed by experienced surgeons, may result in less postoperative pain, early hospital discharge, less use of analgesics, reduced risk of wound infection and incisional hernias, and cosmetic benefits [5,6]. Some authors also suggest that MIS is able to maintain delayed-type hypersensitivity of T cells and proliferation rates of B and T cells, while decreasing rates of tumor cell turnover and increasing both monocyte cytotoxicity and tumor cell apoptosis [42,43].…”

“…The well-recognized benefits of minimally invasive surgery (MIS), such as reduced pain, minimal blood loss, early discharge, rapid recovery and minimal scars, as well as less intracavitary adhesion formation, have encouraged surgeons to expand its use to many diseases of adults and also children [1][2][3][4][5][6].…”

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac

“…[3,4] Due to minimal trauma, less pain, less bleeding, faster recovery and short treatment time, laparoscopic techniques have been demonstrated to be efficient and safe in children. [5,6] However, the laparoscopic approach may lead to side effects such as pulmonary hypertension, hypercapnia, and acidosisbecause of the establishment of capnoperitoneum. [7,8] Moreover, some authors think that the hernia recurrence rate is higher after laparoscopic repair when compared to open operation of indirect hernias in children.…”

Clinical Issues—July 2010

“…For heavier or taller patients, an intra‐abdominal pressure of 20 mm Hg to 30 mm Hg may be necessary to establish the appropriate pneumoperitoneum 8 . For pediatric patients, the insufflation pressures should be set as low as possible while still creating the pneumoperitoneum; however, there are no known studies that define standard ranges for intra‐abdominal pressures in pediatric patients 9 . Intrauterine pressures should be monitored to remain at less than 100 mm Hg to help minimize the risk of gas embolization 1…”