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Miniature Access Surgery in Children
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Types of MAS• Endoscopy• Vaginal hysterectomy• Vascular access• Transurethral resection of the prostate• Percutaneous endoscopic gastrostomy• Angiography and angioplasty• Arthroscopy• Laparoscopy and thoracoscopy
(1987: 1st Laparoscopic Cholecystectomy)
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Historical Resistance to Pediatric MAS• “Children don’t experience pain.”• “We already use small incisions anyway.”• “Laparoscopy is only of cosmetic value.”• “Laparoscopic cases don’t really apply to children.”• “Just because we can do it, should we?”• “It’s too expensive.”• “We don’t have small enough equipment.”• “It’s too hard to do, and too hard to learn.”• “The cases take too long to set up, and to do.”
A little history: Concept of asepsis took 20 years to be accepted
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Smaller wounds
Fewer pulmonary complications
Shorter stays in the hospital
Quicker return to home
Quicker return to school
Quicker return to unrestricted activities
Parents return quicker to work
Smaller wounds
Fewer pulmonary complications
Shorter stays in the hospital
Quicker return to home
Quicker return to school
Quicker return to unrestricted activities
Parents return quicker to work
Pediatric Miniature Access Surgery
Advantages
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Here is the Laparoscopic’s Analgous Bottle in Which to Build that Ship
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Pediatric MIS Applications
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Appendectomy
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Mesoappendix
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Appendectomy, continued
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Stapling the Mesoappendix
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Stapling the appendiceal base
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Splenectomy
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Accessory Spleens
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Stapling the Splenic Hilum
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Splenic Cyst
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Cholecystectomy
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Transecting the Cystic Duct
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Mobilizing the Gallbladder
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Hirschsprung Disease
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Laparoscopic Mobilization of the Rectosigmoid
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Hirschsprung Disease Hirschsprung Disease Incisionless Pull through:Incisionless Pull through:MucosectomyMucosectomy
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Hirschsprung Disease Hirschsprung Disease Incisionless Pull through:Incisionless Pull through:Pull through & AnastomosisPull through & Anastomosis
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Pectus Excavatum
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PECTUS EXCAVATUMMiniature Access Pectus Repair
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PECTUS EXCAVATUMMiniature Access Pectus Repair
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PECTUS EXCAVATUMMiniature Access Pectus Repair
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PECTUS EXCAVATUMMiniature Access Pectus Repair
Pre-Op
Post-Op
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Nephrectomy and Donor Transplant Nephrectomy
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Nephrectomy for Polycystic Disease
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Transplant Donor Nephrectomy
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Thoracoscopy
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Heller myotomy
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Operations on the Ovary
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Ovarian Cyst in a 10 month old
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Laparoscopy in a patient with Gastrointestinal Bleeding
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Nissen Fundoplication
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The Nissen Fundoplication
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Suturing the Wrap
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One month after a laparoscopic Nissen Fundoplication
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Pyloromyotomy
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Hypertrophic Pyloric StenosisHypertrophic Pyloric StenosisOpen PyloromyotomyOpen Pyloromyotomy
Antrum
Pylorus
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The Pyloric Olive
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Pyloromyotomy
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“Old School”
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One month follow-up after laparoscopic Pyloromyotomy