Laparoscopy in Children and Infants

The “first do no harm” ethics of medical care has its age-long influence manifested in the continual search for the least invasive method of administering treatment to the patient. The advancement of the minimally invasive surgery has therefore been a very welcome development in surgical specialities with paediatric surgery not left behind in this quest. Laparoscopy is the visual inspection of the peritoneal cavity aided by a telescope and facilitated by the creation of a pneumoperitoneum. The earliest description of diagnostic laparoscopy was by Cortesi et al., (1976). However, diagnostic laparoscopy was originally introduced in 1910 by the Swedish physician – Hans Christian Jacobeus who published his results from diagnostic laparoscopy and thoracoscopic procedures (Badani et al., 2006). Therapeutic laparoscopy was made popular following the description of laparoscopic appendicectomy by a German gynaecologist Kurt Semm in 1983 (Semm, 1983) and of laparoscopic cholecysytectomy by the German surgeon – Erich Muhe in 1985 (Badani et al., 2006). Advancements in development of instrument components particularly illumination, optics, fiberoptic transmission, insufflation and video-apparatus have progressed alongside development of techniques for minimal access into the abdominal cavity. Development of paediatric laparoscopy was marked by Gans in his contribution to the development of paediatric instruments in 1970 (Tantoco et al., 2005). Laparoscopy offers the surgeon the option of achieving high standard surgical treatment while keeping tissue trauma to a minimum. Since the early 20th century, laparoscopic approach to surgical treatment has gained increasing popularity. However, the paediatric surgical subspecialty has lagged behind adult surgery in exploring the advances offered by laparoscopy. This is largely because some common conditions in adults like cholelithiasis which opened the gateway to the explosion in the application of laparoscopic surgery are uncommon in the paediatric age group. In addition, the low volume of corresponding conditions in the paediatric population has made it unattractive to companies involved in manufacturing and developing the paediatric laparoscopic equipment. For example, laparoscopic cholecystectomy which is a relatively non-complex procedure developed faster in the adult population than in children because of the lower case volume in the latter. Higher case volume equates to higher demand which attracts investors. The converse being the case in the paediatric population has hindered enthusiasm among product developers. Development of laparoscopy in the paediatric population has followed the same course as the development and modification of the laparoscopic apparatus to fit this patient group. Advances in paediatric anaesthetic monitoring and support equipment have also made a huge contribution