Feasibility of microlaparoscopy for surgical procedures of advanced complexity in children

Abstract Purpose: We conducted a prospective study to determine the value and the feasibility of the microlaparoscopic approach for surgical procedures of advanced complexity in children. We report our experience with these small instruments. We also report the preliminary results of a recently developed 2.4 mm prototype scope, specifically developed for the present study.

This study includes 15 children (aged two weeks to 11 years; median, 2.8 years). Eighteen procedures with advanced complexity were carried out: Nissen fundoplication, thoracoscopic congenital diaphragmatic hernia repair in a newborn, hiatoplasty with repair of an upside-down-stomach, laparoscopically assisted pull-through for Hirschsprung's disease in a newborn, laparoscopic transperitoneal pyeloplasty and laparoscopy for acute abdominal illness.

No complications occurred due to the exclusive use of 2 mm instruments. All microlaparoscopy procedures were performed successfully except one fundoplication that was converted to an open procedure due to anatomical deformities. The average operative times for the 5 mm and 2 mm groups were similar compared across a similar age and type-of-intervention population.

The microlaparoscopic approach for surgical procedures of advanced complexity in pediatric surgery is feasible, safe, and effective in conditions where they are indicated and are practical in terms of the surgeon's experience and the facilities. The advantages of microlaparoscopy are obvious: minimum access trauma, "nearly scarless" healing, less risk of damage to abdominal organs, the possibility of fewer adhesions and less postoperative pain. We suggest the further consideration of the use of the microlaparoscope for advanced laparoscopic procedures in children.