Miniature Access Surgery in Children

Types of MAS Endoscopy Vaginal hysterectomy Vascular access Transurethral resection of the prostate Percutaneous endoscopic gastrostomy Angiography and angioplasty Arthroscopy Laparoscopy and thoracoscopy (1987: 1 st Laparoscopic Cholecystectomy)

Historical Resistance to Pediatric MAS “Children don’t experience pain.” “We already use small incisions anyway.” “Laparoscopy is only of cosmetic value.” “Laparoscopic cases don’t really apply to children.” “Just because we can do it, should we?” “It’s too expensive.” “We don’t have small enough equipment.” “It’s too hard to do, and too hard to learn.” “The cases take too long to set up, and to do.” A little history: Concept of asepsis took 20 years to be accepted

Smaller wounds Fewer pulmonary complications Shorter stays in the hospital Quicker return to home Quicker return to school Quicker return to unrestricted activities Parents return quicker to work Smaller wounds Fewer pulmonary complications Shorter stays in the hospital Quicker return to home Quicker return to school Quicker return to unrestricted activities Parents return quicker to work Pediatric Miniature Access Surgery Advantages

Here is the Laparoscopic’s Analgous Bottle in Which to Build that Ship

Pediatric MIS Applications

Appendectomy

Mesoappendix

Appendectomy, continued

Stapling the Mesoappendix

Stapling the appendiceal base

Splenectomy

Accessory Spleens

Stapling the Splenic Hilum

Splenic Cyst

Cholecystectomy

Transecting the Cystic Duct

Mobilizing the Gallbladder

Hirschsprung Disease

Laparoscopic Mobilization of the Rectosigmoid

Hirschsprung Disease Incisionless Pull through: Mucosectomy

Hirschsprung Disease Incisionless Pull through: Pull through & Anastomosis

Pectus Excavatum

PECTUS EXCAVATUM Miniature Access Pectus Repair

 Pre-Op Post-Op 

Nephrectomy and Donor Transplant Nephrectomy

Nephrectomy for Polycystic Disease

Transplant Donor Nephrectomy

Thoracoscopy

Heller myotomy

Operations on the Ovary

Ovarian Cyst in a 10 month old

Laparoscopy in a patient with Gastrointestinal Bleeding

Nissen Fundoplication

The Nissen Fundoplication

Suturing the Wrap

One month after a laparoscopic Nissen Fundoplication

Pyloromyotomy

Hypertrophic Pyloric Stenosis Open Pyloromyotomy Antrum Pylorus

The Pyloric Olive

Pyloromyotomy

“Old School”

One month follow-up after laparoscopic Pyloromyotomy