Minimally invasive surgery
Minimally invasive procedures
Technological advancements have now allowed surgeons to do many surgical procedures in a minimally invasive manner. Instead of traditional incisions, which may require weeks for complete healing, minimally invasive procedures use instruments that allow physicians to see inside the body and perform the needed procedures with only small incisions for more rapid healing.
Thoracoscopic procedures involve the chest, while laparoscopic procedures involve the abdomen. Scopes used in either area are useful for diagnostic testing, however many therapeutic interventions can also be done via scopes with special instruments designed for use through access tubes.
Examples of procedures that lend themselves well to minimally invasive surgery are some cases of appendectomy, many cases of intra-abdominal or interthoracic biopsy, reconstruction of congenital lesions, identification and descent of a non-descended testis, some forms of chest wall reconstruction and diagnostic thoracoscopy/diagnostic laparoscopy. The technology for minimally invasive procedures is changing rapidly, however, and the list of possible procedures done with scopes is in constant revision.
Now Children's Memorial also offers for children the da Vinci® robot-assisted system that is particularly well-suited for complex intra-abdominal procedures and reconstructive urological surgery. About 80 percent of its use in children is in urology. More here about the system.
There are a host of reasons why thoracoscopic/laparoscopic procedures may be indicated or contraindicated for any given child. If a family is interested in exploring these, a thorough discussion with the attending pediatric surgeon should occur. In addition, surgeons will present these alternatives when they think they are in the best interest of the child.
Single incision laparoscopic surgery (SILS)
Staff members within the division are now performing single incision laparoscopic surgery (SILS) for a number of different procedures including, but not limited to appendectomy, cholecystectomy and intussusception. SILS is a technique by which all the laparoscopic instruments are placed through the same incision at the umbilicus. The incision, which is buried within the folds of the umbilicus, is essentially lost deep down in the umbilicus and leaves no obvious scarring.
After a month of healing, most of these scars at the umbilicus are not visible. For the sake of comparison, a traditional laparoscopic appendectomy usually takes three separate incisions to remove the appendix; one of which is hidden in umbilicus, and two of which are visible on the lower abdomen. However, with a SILS appendectomy, the single incision is hidden within the umbilicus. Physicians at Children's Memorial are currently studying the pain associated with SILS, but suspect that there will be less pain as there is only one incision.
SILS requires advanced laparoscopic skills. However, with these advanced skills, many common operations can now be successfully and safely completed using a single incision laparoscopic technique.