Guide Pediatric Minimal Access Surgery (No Series)

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This is particularly useful when the need arises to produce evidence or substantiate change. Equipment manufactures are continually improving the design and picture quality of the endoscopes. Images can be recorded on tape for later examination or for teaching purposes. The next 10 years will see electronic developments, for example, the merging of ultrasound and endoscopy. The range of equipments on offer will expand and improve, allowing more freedom of choice and more competitive prices. Accessories are continually being modified to meet the requirements of new MAS procedures.

Robotic surgery is a new technology which may expand the variety of operations a surgeon can perform with minimal invasive techniques.

Pediatric Minimal Access Surgery

Robotic surgery improves MAS through a more natural interface, tremor filtration, motion scaling, and additional degrees-of-freedom of the instruments. The high equipment and procedural cost, however, is restrictive for its use in India at present. In the future, computer simulation of virtual reality promises to be an excellent method of training in endoscopic procedures.

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It will provide an alternative method of teaching, requiring no patient involvement. Visual links provided by telecommunication lines could also provide distance learning, allow diagnosis, or second opinion. Microchips or smart cards may be used to hold case notes and be worn by the patient, allowing instant retrieval of medical history, endoscopic findings, etc. Despite the many exciting new challenges technology may provide for us, we need to embrace such advances while continuing to provide a high standard of holistic care, tailored to meet individual patients' needs.

With the huge number of patients that we cater to in India, we should also be looking to organize multicenter randomized clinical trails to give a scientific directive on various controversial issues and also validate or challenge the presumed benefits of pediatric MAS in the near future. National Center for Biotechnology Information , U. J Indian Assoc Pediatr Surg.

Prevention & Management, 3rd Edition

Anirudh Shah. Author information Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History of Minimally Invasive Surgery

After a decade of work in MAS and a personal experience of almost cases, time has come to pause, analyze, and group the MAS procedures into the following: MAS as gold standard: MAS has been undoubtedly established as gold standard for evaluation and treatment of impalpable undescended testis, appendicitis, gall stones, early empyema, recurrent abdominal pain, and intersex problems. MAS as a boon: Single stage endorectal pull through in Hirschsprung's disease has been widely accepted.

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However, the scientific benefit to such an attitude is yet to be shown [10]. Laparoscopy can also easily localize presence or absence of testis beyond any doubt. In 42 children, single stage orchidopexy was done with no testicular loss. This is comparable to the previously published data with postoperative follow-up [11].

The single stage approach is feasible on short segment disease without massive proximal dilatation. Our experience is still very early and numbers are small to make any definite conclusion on this approach. Laparoscopic paediatric renal surgery has become an attractive alternative to open surgery and is being done in several centers [12]. In our patients the indications for laparoscopic nephrectomy were symptomatic multicystic dysplastic kidneys MCDK and non functioning kidneys secondary to pelviureteric junction obstruction or reflux nephropathy and laparoscopic pyelolithotomy for a pelvic stone with large extrarenal pelvis.

Even complex conditions like poorly functioning kidney with ureterocele have been managed in one stage laparoscopic surgery. In this study there has been low threshold for conversion to avoid morbidity. Laparoscopic splenectomy is an attractive option in children with small spleen, typically those who have early diagnosis of hemolytic anemia like hereditary spherocytosis [13]. Those with large spleen like portal hypertension of Thalassemia continue to be removed by open surgery. We have followed both approaches with selective use of laparoscopic approach and no morbidity.

Complications of Pediatric Minimal Access Surgery - The 3rd Edition: Prevention & Management

Our results suggest that MAS can be done in children without lowering the bar of quality outcomes in surgery. Contributors: Both authors are responsible for conduct of the study and draft of the manuscript. Udwadia TE. Laparoscopy in India- A personal perspective. J Minim Access Surg.

Minimal access surgery in children-5 years institutional experience. Minimally invasive pediatric surgery: our experience. J Indian Assoc Pediatr Surg.

Laparoscopic vs open appendectomy in children: outcomes comparision based on age, sex and perforation status. Arch Surg. Laparoscopic versus open surgery for suspected appendicitis.

A decade of minimal access pediatric surgery in India

Cochrane Database System Rev. Laparoscopic versus open appendicectomy: An Indian perspective. Paediatric cholelithiasis and Laparoscopic management: A review of twenty two cases. Video assisted transumblical Meckels diverticulectomy in children. Ann Surg. Schier F. Laparoscopic inguinal hernia repair- a prospective personal series of children. J Pediatr Surg. Alzahem A. Laparoscopic versus open inguinal herniotomy in infants and children: A meta-analysis.