Miniature Access Surgery in Children

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)

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

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

Here is the Laparoscopic’s Analgous Bottle in Which to Build that Ship

Pediatric MIS Applications

Appendectomy

Mesoappendix

Appendectomy, continued

Stapling the Mesoappendix

Stapling the appendiceal base

Splenectomy

Accessory Spleens

Stapling the Splenic Hilum

Splenic Cyst

Cholecystectomy

Transecting the Cystic Duct

Mobilizing the Gallbladder

Hirschsprung Disease

Laparoscopic Mobilization of the Rectosigmoid

Hirschsprung Disease Hirschsprung Disease Incisionless Pull through:Incisionless Pull through:MucosectomyMucosectomy

Hirschsprung Disease Hirschsprung Disease Incisionless Pull through:Incisionless Pull through:Pull through & AnastomosisPull through & Anastomosis

Pectus Excavatum

PECTUS EXCAVATUMMiniature Access Pectus Repair

PECTUS EXCAVATUMMiniature Access Pectus Repair

PECTUS EXCAVATUMMiniature Access Pectus Repair

PECTUS EXCAVATUMMiniature Access Pectus Repair

Pre-Op

Post-Op

Nephrectomy and Donor Transplant Nephrectomy

Nephrectomy for Polycystic Disease

Transplant Donor Nephrectomy

Thoracoscopy

Heller myotomy

Operations on the Ovary

Ovarian Cyst in a 10 month old

Laparoscopy in a patient with Gastrointestinal Bleeding

Nissen Fundoplication

The Nissen Fundoplication

Suturing the Wrap

One month after a laparoscopic Nissen Fundoplication

Pyloromyotomy

Hypertrophic Pyloric StenosisHypertrophic Pyloric StenosisOpen PyloromyotomyOpen Pyloromyotomy

Antrum

Pylorus

The Pyloric Olive

Pyloromyotomy

“Old School”

One month follow-up after laparoscopic Pyloromyotomy