FUTURE TECHNIQUES OF MINIMALLY INVASIVE SURGERY

For the past four decades, patients have increasingly chosen the minimally invasive option for their surgical needs to avoid the morbidity of large incisions, and this generally has led to shorter hospital stays, less pain medication requirements, and earlier returns to normal activity levels in adult patients.

The advantages of minimally invasive surgery also apply to pediatric patients and especially for those who have undergone ablative pediatric surgical procedures with similar benefits seen in these patients. The first reported use of laparoscopy in pediatric surgery was reported in the 1960s, and diagnostic laparoscopy in this setting has gained widespread acceptance among pediatric surgeons. Over the last two decades, laparoscopic surgical techniques have improved significantly in the adult and pediatric patient populations both by the use of conventional laparoscopy.

In children, this has led to a reliably safe and effective approach to the pediatric surgical techniques that require extensive suturing with similar success rates and potential benefits with regard to cosmetics, intraoperative blood loss, postoperative stay, and the length of the overall hospital stay.

However, for the pediatric surgery, the limitation of conventional laparoscopic equipment and the steep learning curve associated with its use to only a modest adoption among pediatric surgeons for these type of procedures. The da Vinci Surgical System from Intuitive Surgical(Sunnyvale, CA) has introduced the benefits of intuitive interface, three-dimensional articulation and control that allow for robotic-assisted laparoscopic procedures. The increased precision of and facility with instrumentation offered by robotic assistance and readily seen in pediatric surgical procedures. 

This has helped to increased the utilization of minimally invasive techniques for pediatric surgical procedures. Laparoscopic surgery is equipment intensive. Adaptations of adult laparoscopic instruments continue to be made for appropriate application and improvement of safety of laparoscopic procedures in infants and children. Instrumentation for open surgery has seen relatively little change over the last few decades.

Laparoscopic pediatric surgical procedures has requirement for instruments involves gaining access, visualization, placement of instrument, dissection and hemostasis of target tissue, extraction of specimens and wound closure.