Related Experiment Video
Updated: Aug 11, 2026
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Laparoscopic surgery in infants and children
1Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 80590, 3508 AB Utrecht, The Netherlands. N.Bax@wkz.azu.nl
Insights
Endoscopic surgery offers faster recovery and better cosmetic results compared to open surgery, despite a slightly higher complication rate. This minimally invasive approach is transforming pediatric surgical practices and patient care.
Area of Science:
- Minimally Invasive Surgery
- Pediatric Surgery
- Surgical Innovation
Background:
- Traditional open surgery is increasingly being replaced by endoscopic surgical variants across various procedures.
- The principle of 'the less invasive the better' is supported by evidence linking reduced trauma to decreased stress response and immunosuppression.
- While evidence in children is limited, adult studies suggest endoscopic surgery leads to faster recovery, improved cosmesis, and fewer adhesions.
Purpose of the Study:
- To evaluate the impact and implications of endoscopic surgery in pediatric practice.
- To compare outcomes, including recovery, cosmesis, and complications, between open and endoscopic surgical approaches in children.
- To analyze the shift in surgical mentality and its effects on pediatric surgeons and nursing staff.
Main Methods:
- Review of existing literature comparing open and endoscopic surgery, with a focus on pediatric populations.
- Analysis of evidence from adult studies regarding recovery, cosmesis, adhesions, and complication rates.
- Qualitative assessment of the impact of endoscopic surgery on surgical and nursing practices and patient/parent experience.
Main Results:
- Endoscopic surgery is associated with faster recovery, better cosmetic outcomes, and fewer adhesions compared to open surgery.
- While complication rates may be slightly higher, the overall efficiency is improved due to shorter hospital stays.
- The adoption of endoscopic surgery has influenced a shift towards less invasive techniques, even in open procedures, and altered nursing perceptions and patient management.
Conclusions:
- Endoscopic surgery represents a significant advancement in pediatric surgery, aligning with the principle of minimal invasiveness.
- The benefits of faster recovery and improved cosmesis are notable, though careful monitoring for complications is necessary.
- The widespread adoption of endoscopic techniques necessitates adaptation in surgical training, nursing care, and patient/parent education to optimize outcomes and manage expectations.
Abstract:
Almost all operations that are classically performed as open surgery have now an endoscopic surgical variant. The reason for performing this form of surgery obeys the Hippocratic principle: The less invasive the better. Moreover there is scientific evidence that the less trauma, the less stress response and the less immunosuppression. There are few well conducted studies in children comparing open with endoscopic surgery, but evidence is piling up, especially from studies in adults, that endoscopic surgery results in a faster recovery, better cosmesis and fewer adhesions. The complication rate seems, however, slightly higher. Endoscopic surgery takes more time but hospital stay is shorter so that the same output can be achieved with fewer beds. Endoscopic surgery has changed the mentality of pediatric surgeons. Nowadays pediatric surgeons think more in terms of invasiveness which means that even in open surgery incisions are not as large anymore as they have been in the past. Endoscopic surgery has also changed the mentality in nursing. The wounds do not anymore reflect the magnitude of the surgery that has been performed internally, which may lead to an underestimation of pain. As the turnover of patients is much higher, there is less patient and parent binding. Lastly some parents may be overwhelmed by the rapid discharge and nurses have to guide them. Some nurses feel that the ward has become less surgical, which may have an impact on recruitment.
