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Enthusiasm, evidence and ethics: the triple E of minimally invasive pediatric surgery
1Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. ure.benno@mh-hannover.de
Insights
Minimally invasive surgery (MIS) in pediatric patients shows benefits in some procedures, but robust evidence is limited for many others. Further research and ethical considerations are crucial for future recommendations on MIS in children.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Evidence-Based Medicine
Background:
- Minimally invasive surgery (MIS) is applicable to over 60% of pediatric abdominal and thoracic operations.
- While promoted for years, high-level evidence supporting MIS advantages in children is scarce.
- Randomized controlled trials (RCTs) exist for specific procedures like laparoscopic appendectomy and hernia repair.
Discussion:
- RCTs confirm some MIS benefits, but data for most laparoscopic and all thoracoscopic procedures are lacking.
- The article examines complications and disadvantages of MIS in pediatric surgery.
- Ethical implications of adopting new surgical techniques in children are also discussed.
Key Insights:
- Limited level 1 evidence exists for the advantages of MIS in many pediatric surgical procedures.
- Existing RCTs support MIS for select procedures, but broader validation is needed.
- Complications, disadvantages, and ethical considerations are vital for evaluating MIS in pediatric patients.
Outlook:
- Evidence-based data and ethical principles are essential for future MIS application in pediatric surgery.
- Further high-quality research is required to establish definitive benefits for a wider range of procedures.
- MIS may be appropriately integrated into pediatric surgical practice with continued evaluation.
Abstract:
Minimally invasive techniques are applicable in more than 60% of abdominal and thoracic operations in children. Enthusiasts promoted these techniques for many years. However, level 1 evidence on advantages of minimally invasive surgery in children remains limited. Randomized controlled trials have been conducted for some types of procedures such as laparoscopic appendectomy, fundoplication, pyloromyotomy, and inguinal hernia repair. The results of these studies confirm some advantages of minimally invasive surgery, but for most types of laparoscopic and all types of thoracoscopic procedures, such data remain to be established. This article also focuses on reports on complications and disadvantages which are relevant for final conclusions and recommendations. The ethical implications of the application of new techniques in children are also discussed. On the basis of evidence based data and ethical principles, minimally invasive techniques may be appropriately used in the future.
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