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Laparoscopic surgery in children
  1. P K H Tam
  1. Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong Medical Center, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
  1. Professor Tam email: paultam{at}

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Laparoscopic surgery in children is not new. Paediatric surgeons were among the pioneers of laparoscopic surgery in the early 1970s,1 but the vast potential of this “minimally invasive” approach to treat children with surgical conditions has only recently begun to be realised. For over two decades, paediatric laparoscopy was restricted mainly to diagnostic use. In the early 1990s, an explosive expansion of laparoscopic surgery occurred in adults as a result of the success of laparoscopic cholecystectomy. Nevertheless, interest in laparoscopic surgery in children remained confined to a few enthusiasts initially,2-4 while the rest of the paediatric surgical community adopted a “wait and see” attitude. More recently however, with increasing experience in paediatric laparoscopic procedures,5-7 and advances in miniaturised instrumentation, laparoscopy's place in the modern paediatric surgical armamentarium has finally become accepted. In the USA, it is estimated that 82% of paediatric surgeons perform laparoscopic surgery.8 The question is no longer whether laparoscopic surgery should be done in children, but what conditions should be treated laparoscopically.


Laparoscopic surgery involves insertion of a telescope for visualisation, and additional ports for therapeutic instrumentation under general anaesthesia. Initially, adequate illumination and clear images were obtainable only with relatively large telescopes, but in the past few years good quality paediatric telescopes as little as 2 mm in diameter have become available. The telescope is usually inserted through the umbilicus, resulting in an invisible scar. The image is transmitted to one or more television monitors.

The number of instrumentation ports needed is related to the complexity of the therapeutic procedure—for example, one or two for laparoscopic clipping of varicocele, four for laparoscopic fundoplication. The laparoscopic instruments are designed for the same purposes as those used in open surgery: tissue holding, dissection, retraction, haemostasis, suturing, etc. These days, most paediatric laparoscopic instruments measure 2–5 mm …

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