Overview of laparoscopy in children and adolescents
- Marc R Laufer, MD
Marc R Laufer, MD
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- David E Reichman, MD
David E Reichman, MD
- Clinical Fellow
- The Ronald O Perelman Claudia Cohen Center for Reproductive Medicine
- New York Presbyterian Hospital
- Weill Cornell Medical College
- Charles Jason Smithers, MD
Charles Jason Smithers, MD
- Instructor in Surgery
- Harvard Medical School
- Section Editors
- Tommaso Falcone, MD, FRCSC, FACOG
Tommaso Falcone, MD, FRCSC, FACOG
- Section Editor — Minimally Invasive Gynecologic Surgery
- Professor of Obstetrics and Gynecology
- Cleveland Clinic Lerner College of Medicine
- Jeffrey Marks, MD
Jeffrey Marks, MD
- Section Editor — Minimally Invasive Surgery
- Professor of Surgery
- University Hospitals
- Case Medical Center
Use of laparoscopic surgery in the pediatric population is rapidly increasing. 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 .
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 .
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".)
PREOPERATIVE EVALUATION AND PREPARATION
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".)
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- PREOPERATIVE EVALUATION AND PREPARATION
- Informed consent
- OPERATIVE SET-UP
- Measures to reduce anxiety
- Patient positioning
- - Position of arms
- - Specific types of procedures
- Gynecologic procedures
- General surgery procedures
- INCISION SITES
- Insufflation pressure and volume
- - Managing adverse reactions to insufflation
- Absorption of carbon dioxide
- Laparoscopic entry protocols
- - Gynecologic procedures
- - General surgery procedures
- Vascular or visceral injury
- Port site hernia
- - Fascial closure
- SUMMARY AND RECOMMENDATIONS