Transubilical Laparoscopically Assisted Pediatric Surgery

Endoscopic surgery has revolutionized pediatric surgery in the past twenty years. Number of operations that were previously performed through abdominal wall incisions can now be completed using endoscopic surgical techniques. The degree to which pediatric surgeons have incorporated minimally invasive surgery into their daily practice is amazing as well as the range of performed procedures. By the end of the year 2010, more than 43000 papers have been published in prereviewed medical literature with the title containing words minimally invasive or laparoscopy. Among them, more than 3500 were in the field of pediatric surgery. Around seventy procedures have been described and one quarter of them has wide acceptance as the treatment of choice. Continuous efforts to minimize scarring from surgery led surgeons to explore new innovative and even less invasive solutions. Laparoscopic surgery using instruments in reduced sizes (mini & microlaparoscopy), two-port endoscopic surgery and less visible port laparoscopy (suprapubic and lateral –“hidden incisions”) were described as initial attempts. NOTES natural orifice translumenal endoscopic surgery as a completely non visible scar procedure advocated by some general surgeons hasn’t found supporters among pediatric surgeons. Idea of an endoscope passing through a natural orifice and then a internal incision in the stomach, vagina, bladder or colon, thus avoiding any external incisions or scars to perform surgery has numerous limitations. Question whether the improved cosmesis is worth the risk of visceral injury is the basic complaint about NOTES. So for the vast majority of surgeons the most promising less invasive endoscopic surgery concept is a single incision laparoscopic surgery. This is a broad concept of single entry port surgery, applicable in abdomen, pelvis and thorax, performed by laparoscopes, scopes with working channels and endoscopes with flexible tips, and completed intraabdominaly or partly extracorporealy. Plenty of terms and acronyms exist to describe broad concept of single incision surgery. Laparoendoscopic single-site surgery consortium for assessment and research (LESCAR), a multidisciplinary group of experts of various specialties, has recently reached a consensus on nomenclature and advocate the term laparoendoscopic single-site surgery (LESS). This concept has gained immense popularity throughout the world within the past few years. General surgeons as well as pediatric surgeons perform LESS in wide range of indications and volume of procedures inclines steadily.