Emerging Techniques in Minimally Invasive Surgery in Hematologic Malignancies

Hematologic malignancies represent the most common cancers in children. While the mainstays of treatment are chemotherapy and potentially hematopoietic stem cell transplant, minimally invasive surgery (MIS) has a role in the diagnosis and management of complications related both to disease and therapy as well as common pediatric surgical conditions. MIS can be considered in the management of adverse events of disease and therapy such as pneumatosis, bowel perforation, or pneumoperitoneum in stable patients as a first-look alternative to open surgery. Additionally, given the extent of therapy for many children, common surgical problems such as the need for enteral access, appendicitis, and cholecystitis can occur, and laparoscopic options should be considered for management to enable a faster return to chemotherapy. Finally, MIS can assist with diagnosis through lymph node or tissue biopsy. The utilization of MIS in pediatric patients with hematologic malignancies is a safe and feasible approach for a variety of surgical problems. Nevertheless, current evidence is largely limited to retrospective series and case reports, and prospective multicenter studies will be required to validate these approaches and emerging technologies such as augmented reality and robotics.