Laparoscopy in Children by Felix Schier, Salmai Turial

By Felix Schier, Salmai Turial

When Laparoscopy in Children used to be first released in 2003, it speedy grew to become well liked by pediatric surgeons around the world because of its transparent schematic drawings and concise textual content. This new version has been revised and enlarged to hide the hot tactics and different advances that experience emerged within the intervening interval, within which the variety of operations has virtually doubled. Now, nearly all of symptoms for laparoscopy in little ones are offered and mentioned. each one operation is systematically defined and illustrated step-by-step, offering the reader with the technical instructions required to accomplish laparoscopy adequately even in babies. Laparoscopy in Children may be a useful advisor for all surgeons who practice, or plan to accomplish, such operations.

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The minimally invasive approach is suitable in otherwise healthy children. If, however, the child is seriously compromised, an “open” subcostal approach is quicker. Trocar position: The patient lays on his healthy side, unfortunately. The thoracoscope is inserted high up in the thorax. Remember that the surgeon needs to work in the lateral lower area of the thorax. So he stands just next to the anaesthesiologist. Two additional trocars are inserted to the left and right for the surgeon’s hands.

6 3 Thoracoscopic Procedures Sympathectomy The patient is in supine position with both arms extended at 90°. The procedure can be completed with 2- or 3-mm instruments and scopes exclusively. Insert a scope 5–7 cm below the axilla in the axillary line and one or two additional 2-mm trocars laterally. Two trocars should suffice if the lung collapses well enough (with singlelung ventilation). If not, a third 2-mm trocar is inserted in order to push the lung out of the way (Fig. 20). Wait a minute for the lung to collapse.

If this is insufficient, an additional 2- or 3-mm instrument is inserted also at the xiphoid in order to further elevate the lower pole of the spleen. This stretches any adhesions between the lower pole and the omentum. Further trocars for the surgeon’s hands are inserted in the left and right middle or lower abdomen, depending of the spleen’s size. We use a 3-mm trocar for the left and a 5-mm trocar for the right hand, 5-mm in order to pass the LigaSure® (Fig. 15). 4 Splenectomy 57 Surgeon Laparoscope Assistant Fig.

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