Minimally Invasive Surgery
Minimally invasive surgery dates back to 1910 when Hans Christian Jacobaeus performed the first diagnostic laparoscopy. In 1999 Lobe et al. reported the first repair of oesophageal atresia – a challenging congenital anomaly – entirely thoracoscopically, this being accomplished on a 2-3 kg new born baby. Technological advances combined with increasing surgical and anaesthetic expertise have broadened the range of laparoscopic procedures presently being undertaken in children, from the neonatal period through to adolescence.
Over the last 15 years this field of minimally invasive or endoscopic surgery in childhood has become well established. As the advances present themselves and aid the progress of this field, the efficacy of these procedures in children is evident. Currently, an endoscopic variant of almost every open procedure has been developed and is available.
Minimally invasive surgery as the name suggests consists of surgical procedures performed through tiny incisions. Essentially what it means is that whilst the principles of the operative procedure remain the same, the approach and access to the particular organ has changed dramatically. The view of the body cavity is acquired with the help of an illuminated telescope connected to a television monitor of a very high resolution which therefore provides a magnified field with crystal clear definition.
The major benefits from these minimally invasive procedures are therefore- the small incisions and scars with better cosmetic effects, less surgical manipulations and stress, decreased post-operative pain, earlier enteral feeding, decreased postoperative ileus and complications, hence early return of bowel function and more rapid recovery. Laparoscopic procedures may also be cost-effective due to the shorter length of hospital stay although the initial equipment cost may be higher.
Technically, laparoscopy in children is very demanding and challenging because of their small body habitus as well as the wide spectrum and complexity of the various disease processes that affect them. It is therefore, imperative and essential for surgeons undertaking laparoscopic procedures in children to be equipped not only with the technical knowledge, but to also be familiar with the basic science which underpins this practice. This requires formal training, at tertiary hospitals of excellence, that deal with advanced endoscopic surgery in children on a regular basis, and where structured training programs for Paediatric Surgeons are made available. As is often stated, Laparoscopic Surgery entails two learning curves. First is the learning curve of the instruments and second, the learning curve of each procedure.
Many pediatric surgical procedures performed laparoscopically and thoracoscopically seem to have definite benefits, and in certain situations have even been proven to have better outcomes for the patient as compared to traditional open surgery.
A wide variety of Laparoscopic and thoracoscopic procedures for childhood surgical diseases are offered at Gleneagles Medical Centre (GMC) for children and adolescents
Gastro-Intestinal (GIT) Surgery
- Upper and Lower GIT flexible and rigid diagnostic and therapeutic endoscopy
- Diagnostic Laparoscopy for investigation of chronic abdominal pain
- Insertion of Buttons and feeding tubes for feeding purposes
- Meckel’s Diverticulectomy
- Management of certain ano-rectal anomalies
- Management of Hirschprung’s Disease of the colon
- Diagnostic Cholangiogram
- Excision of Choledochal Cyst
- Liver Biopsy
- Cystoscopy- Diagnostic and therapeutic
- Diagnosis and Management of Intra abdominal testis
- Management of Varicocoele
- Excision of Urachal anomalies
- Partial and total Nephrectomy
- Bronchoscopy- Diagnostic and therapeutic
- Video Assisted Thoracoscopic Surgery for Empyema
- Excision of lesions of the lung and biopsy
- Treatment of Pectus Excavatum
- Management of ovarian cysts in children
- Tumour biopsies and excision