Minimal Access Surgery in Paediatric Patients

Introduction It is difficult to credit any one person for the development of minimal access surgery (MAS) (also referred to as minimally invansive surgery, or MIS, by some), but diagnostic laparoscopy has been used in various medical specialties since early in the 20th century. Laparoscopy was commonly used by gynecologists throughout the 1960s and 1970s. Semm performed the first laparoscopic appendectomy in 1980, and Mouret performed the first laparoscopic cholecystectomy in 1987, leading to the widespread application of this technology to general surgery.1,2 In Africa, diagnostic laparoscopy is sometimes the only method to make or confirm a diagnosis because other, less invasive modalities, such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), often are not available. However, advanced laparoscopic techniques are being utilised only in select regions; other areas basically perform almost no minimal access surgery. Minimal access operations have been developed for most adult general surgical procedures; however, technical limitations, such as the size of the scopes and instruments, have made the application to paediatric surgery more guarded. As smaller and more delicate instruments have been developed and minimal access techniques have become standard teaching in general surgical training programmes, there has been a greater number of children treated with laparoscopic or thoracoscopic operations.3 This chapter briefly discusses the general concepts of laparoscopy and thoracoscopy and reviews the current applications of MAS in the paediatric population, with an emphasis on those basic procedures that may be the most relevant in Africa.