Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Overview of laparoscopy in children and adolescents

Marc R Laufer, MD
David E Reichman, MD
Charles Jason Smithers, MD
Section Editors
Tommaso Falcone, MD, FRCSC, FACOG
Jeffrey Marks, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Use of laparoscopic surgery in the pediatric population is now common. In one United States pediatric tertiary care center, for example, the proportion of appendectomies performed laparoscopically was fewer than 10 percent in 1997 and greater than 95 percent in 2005 [1].

Pediatric surgeons were initially slower to adopt laparoscopic techniques than surgeons for adults. This was due to several limiting factors, including the lack of availability of child or adolescent-size instrumentation, surgical learning curves, and limited case volumes for complex procedures. In recent years, however, there have been marked advances in instrumentation, techniques, and training [2-4]. Minimally invasive approaches have become the standard of care for operations involving the thoracic and abdominal cavities for all ages, including newborn congenital anomalies. As with adult procedures, pediatric laparoscopy offers advantages of fewer major wound-associated complications, less incisional pain, a shorter recovery, and improved cosmesis [5].

Laparoscopy in children and adolescents bears marked similarities to adult procedures, but experience with adult surgery does not sufficiently translate to safe surgery in pediatric patients. Pediatric procedures must be performed with a full understanding of the relevant anatomic and physiologic differences between the pediatric and adult populations.

Unique aspects of laparoscopy in children and adolescents are reviewed here. General principles of laparoscopy, as well as descriptions of specific laparoscopic surgical techniques in the pediatric population, are discussed separately. (See "Abdominal access techniques used in laparoscopic surgery" and "Instruments and devices used in laparoscopic surgery" and "Complications of laparoscopic surgery".)


Informed consent — Informed consent must be obtained from the legal guardian of the patient for any pediatric or adolescent surgery. The age at which adult consent is required varies by jurisdiction and by whether the procedure is elective or emergent and may change over time. Pediatric surgeons should be familiar with the appropriate laws. (See "Consent in adolescent health care".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Zitsman JL. Pediatric minimal-access surgery: update 2006. Pediatrics 2006; 118:304.
  2. Zitsman JL. Current concepts in minimal access surgery for children. Pediatrics 2003; 111:1239.
  3. Meehan JJ, Georgeson KE. The learning curve associated with laparoscopic antireflux surgery in infants and children. J Pediatr Surg 1997; 32:426.
  4. Georgeson KE, Owings E. Advances in minimally invasive surgery in children. Am J Surg 2000; 180:362.
  5. Mattei P. Minimally invasive surgery in the diagnosis and treatment of abdominal pain in children. Curr Opin Pediatr 2007; 19:338.
  6. Mansuria SM, Sanfilippo JS. Laparoscopy in the pediatric and adolescent population. Obstet Gynecol Clin North Am 2004; 31:469.
  7. Broach AN, Mansuria SM, Sanfilippo JS. Pediatric and adolescent gynecologic laparoscopy. Clin Obstet Gynecol 2009; 52:380.
  8. Holcomb GW, Georgeson KE, Rothenberg SS. Atlas of pediatric laparoscopy and thoracoscopy, Saunders, Philadelphia 2008. p.9.
  9. Walsh MT, Vetter TR. Anesthesia for pediatric laparoscopic cholecystectomy. J Clin Anesth 1992; 4:406.
  10. De Waal EE, Kalkman CJ. Haemodynamic changes during low-pressure carbon dioxide pneumoperitoneum in young children. Paediatr Anaesth 2003; 13:18.
  11. Terrier G. Anaesthesia for laparoscopic procedures in infants and children: indications, intra- and post-operative management, prevention and treatment of complications. Curr Opin Anaesthesiol 1999; 12:311.
  12. Pennant JH. Anesthesia for laparoscopy in the pediatric patient. Anesthesiol Clin North America 2001; 19:69.
  13. Lalwani K, Aliason I. Cardiac arrest in the neonate during laparoscopic surgery. Anesth Analg 2009; 109:760.
  14. Kudsi OY, Jones SA, Brenn BR. Carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy: a case report. J Pediatr Surg 2009; 44:842.
  15. Peters CA. Complications in pediatric urological laparoscopy: results of a survey. J Urol 1996; 155:1070.
  16. Chen MK, Schropp KP, Lobe TE. Complications of minimal-access surgery in children. J Pediatr Surg 1996; 31:1161.
  17. Magrina JF. Complications of laparoscopic surgery. Clin Obstet Gynecol 2002; 45:469.
  18. Montero M, Tellado MG, Ríos J, et al. Aortic injury during diagnostic pediatric laparoscopy. Surg Endosc 2001; 15:519.
  19. Yanke BV, Horowitz M. Safety of the Veress needle in pediatric laparoscopy. J Endourol 2007; 21:695.
  20. Cost NG, Lee J, Snodgrass WT, et al. Hernia after pediatric urological laparoscopy. J Urol 2010; 183:1163.
  21. Paya K, Wurm J, Fakhari M, et al. Trocar-site hernia as a typical postoperative complication of minimally invasive surgery among preschool children. Surg Endosc 2008; 22:2724.
  22. Nakajima K, Wasa M, Kawahara H, et al. Revision laparoscopy for incarcerated hernia at a 5-mm trocar site following pediatric laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 1999; 9:294.
  23. Waldhaussen JH. Incisional hernia in a 5-mm trocar site following pediatric laparoscopy. J Laparoendosc Surg 1996; 6 Suppl 1:S89.
  24. Yee DS, Duel BP. Omental herniation through a 3-mm umbilical trocar site. J Endourol 2006; 20:133.
  25. Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg 2004; 139:1248.
  26. Lajer H, Widecrantz S, Heisterberg L. Hernias in trocar ports following abdominal laparoscopy. A review. Acta Obstet Gynecol Scand 1997; 76:389.
  27. Liu CD, McFadden DW. Laparoscopic port sites do not require fascial closure when nonbladed trocars are used. Am Surg 2000; 66:853.
  28. Scott TR, Zucker KA, Bailey RW. Laparoscopic cholecystectomy: a review of 12,397 patients. Surg Laparosc Endosc 1992; 2:191.
  29. A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club. N Engl J Med 1991; 324:1073.