Laparoscopy and thoracostomy in children

The laparoscopic and thoracoscopic revolution is sweeping through pediatric surgery. The current literature has detailed numerous reports of laparoscopic approaches to traditional operations. The most commonly performed and currently most accepted operations are diagnostic laparoscopy, gynecologic laparoscopy, and laparoscopic cholecystectomy and appendectomy. Few, if any, of these procedures have been subjected to a prospective, randomized trial, but initial reports indicate improved postoperative outcome by decreasing hospital stay and an earlier return to normal activities. Thoracoscopic lung biopsy, tumor excision, and treatment of empyema are well-established procedures. Other operations soon to be introduced are laparoscopic fundoplication, laparoscopic-aided intestinal surgery, thoracoscopic excision of mediastinal masses, spinal surgery, and chest wall surgery. The early enthusiasm for minimally invasive surgery must be tempered by an appreciation for its limitations and complications. How surgeons handle this new innovation will determine whether the promise of laparoscopy is another step towards eliminating the negative factors that have made surgery such a dichotomy of fear and hope.