Skip to main content
SpringerLink
Log in

Update zur minimalinvasiven Chirurgie im Kindesalter

Update on minimally invasive surgery in childhood

  • Leitthema
  • Published:
Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Die minimalinvasive Chirurgie (MIC) im Kindesalter hat sich in den letzten 30 Jahren rasant entwickelt. Heute ermöglichen MIC-Instrumente mit einem Durchmesser von 2–3 mm, Insufflatoren mit exakt einstellbaren niedrigen Drücken und Flussgeschwindigkeiten sowie eine stark gewachsene kinderanästhesiologische Expertise selbst bei Neugeborenen die sichere und erfolgreiche Durchführung komplexer MIC-Eingriffe. Nahezu alle in konventioneller Technik etablierten Eingriffe in Abdomen, Retroperitoneum und Thorax sind bereits minimalinvasiv durchgeführt worden. Postulierte Vorteile der MIC im Vergleich zu konventionellen offenen chirurgischen Verfahren sind ein schnellerer Kostaufbau, weniger Schmerzen, bessere Kosmetik und eine kürzere Krankenhausaufenthaltsdauer. Diese Parameter wurden für viele Indikationen in großen Kohortenstudien, randomisierten kontrollierten Studien (RCT) sowie Metaanalysen untersucht. Im Folgenden werden die gegenwärtig in kinderchirurgischen Zentren mit MIC-Expertise durchgeführten Operationen und das damit verbundene Outcome anhand der aktuellen Literatur dargestellt.

Abstract

Minimally invasive surgery (MIS) in childhood has developed rapidly in the last 30 years. Current MIS instruments with a diameter of 2–3 mm, insufflators with precisely adjustable low pressures and flow velocities as well as an increasing expertise in pediatric anesthesiology make it possible to perform complex MIS procedures safely and successfully even in neonates. Almost all conventional abdominal, retroperitoneal and thoracic procedures have now been performed minimally invasively. Postulated advantages of MIS compared to conventional open surgical procedures are faster time to enteral feeding, less pain, better cosmesis and shorter length of hospital stay. These parameters have been studied for many indications in large cohort studies, randomized controlled trials (RCT) and meta-analyses. This review summarizes the procedures currently performed in pediatric surgical centers with MIS expertise and the associated outcomes based on the current literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Lacher M, Kuebler JF, Dingemann J et al (2014) Minimal invasive surgery in the newborn: current status and evidence. Semin Pediatr Surg 23(5):249–256

    PubMed  Google Scholar 

  2. Bax NM, Ure BM, van der Zee DC et al (2001) Laparoscopic duodenoduodenostomy for duodenal atresia. Surg Endosc 15(2):217

    CAS  PubMed  Google Scholar 

  3. Schukfeh N, Kuebler JF, Dingemann J et al (2019) Thirty Years of Minimally Invasive Surgery in Children: Analysis of Meta-Analyses. Eur J Pediatr Surg 23. https://doi.org/10.1055/s-0039-1687901

    Article  PubMed  Google Scholar 

  4. Chung PH, Wong CW, Ip DK et al (2017) Is laparoscopic surgery better than open surgery for the repair of congenital duodenal obstruction? A review of the current evidences. J Pediatr Surg 52(3):498–503 (Mar)

    PubMed  Google Scholar 

  5. Holler AS, Muensterer OJ, Martynov I et al (2019) Duodenal Atresia Repair Using a Miniature Stapler Compared to Laparoscopic Hand-Sewn and Open Technique. J Laparoendosc Adv Surg Tech A 31. https://doi.org/10.1089/lap.2019.0057

    Article  PubMed  Google Scholar 

  6. Abhyankar A, Mukhtar Z (2011) Laparoscopy-assisted surgery for neonatal intestinal atresia: single-center experience. Asian J Endosc Surg 4(2):90–93. https://doi.org/10.1111/j.1758-5910.2011.00075

    Article  CAS  PubMed  Google Scholar 

  7. Catania VD, Lauriti G, Pierro A et al (2016) Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int. 32(12):1157–1164. Epub 2016 Oct 5

    PubMed  Google Scholar 

  8. Sathya C, Wayne C, Gotsch A et al (2017) Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis. Pediatr Surg Int 33(3):325–333 (Mar)

    PubMed  Google Scholar 

  9. Georgeson KE, Inge TH, Albanese CT (2000) Laparoscopically assisted anorectal pull-through for high imperforate anus – a new technique. J Pediatr Surg 35(6):927–930; discussion 930–931

    CAS  PubMed  Google Scholar 

  10. Han Y, Xia Z, Guo S et al (2017) Laparoscopically Assisted Anorectal Pull-Through versus Posterior Sagittal Anorectoplasty for High and Intermediate Anorectal Malformations: A Systematic Review and Meta-Analysis. PLoS ONE 18;12(1):e170421 (Jan)

    Google Scholar 

  11. Rentea RM, Halleran DR, Vilanova-Sanchez A et al (2019) Diagnosis and management of a remnant of the original fistula (ROOF) in males following surgery for anorectal malformations. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2019.02.006

    Article  PubMed  Google Scholar 

  12. Zhang S, Li J, Wu Y et al (2015) Comparison of Laparoscopic-Assisted Operations and Laparotomy Operations for the Treatment of Hirschsprung Disease: Evidence From a Meta-Analysis. Medicine (Baltimore) 94(39):e1632 (Sep)

    Google Scholar 

  13. Lacher M, Froehlich S, von Schweinitz D et al (2010) Early and Long Term Outcome in Children with Esophageal Atresia Treated Over the Last 22 Years. Klin Padiatr 222(5):296–301

    CAS  PubMed  Google Scholar 

  14. Zani A, Eaton S, Hoellwarth ME et al (2014) International survey on the management of esophageal atresia. Eur J Pediatr Surg 24(1):3–8 (Feb)

    PubMed  Google Scholar 

  15. Lal DR, Gadepalli SK, Downard CD et al (2018) Challenging surgical dogma in the management of proximal esophageal atresia with distal tracheoesophageal fistula: Outcomes from the Midwest Pediatric Surgery Consortium. J Pediatr Surg 53(7):1267–1272 (Jul)

    PubMed  Google Scholar 

  16. Wu Y, Kuang H, Lv T, Wu C (2017) Comparison of clinical outcomes between open and thoracoscopic repair for esophageal atresia with tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr Surg Int. 33(11):1147–1157. https://doi.org/10.1007/s00383-017-4153-9. Epub 2017 Sep 15. Review

    Article  PubMed  Google Scholar 

  17. Bogusz B, Patkowski D, Gerus S et al (2018) Staged Thoracoscopic Repair of Long-Gap Esophageal Atresia Without Temporary Gastrostomy. J Laparoendosc Adv Surg Tech A 17. https://doi.org/10.1089/lap.2018.0188

    Article  PubMed  Google Scholar 

  18. Sroka M, Wachowiak R, Losin M et al (2013) The Foker technique (FT) and Kimura advancement (KA) for the treatment of children with long-gap esophageal atresia (LGEA): lessons learned at two European centers. Eur J Pediatr Surg 23(1):3–7 (Feb)

    PubMed  Google Scholar 

  19. Tytgat SHAJ, van Herwaarden-Lindeboom MYA, van Tuyll van Serooskerken ES et al (2018) Thoracoscopic posterior tracheopexy during primary esophageal atresia repair: a new approach to prevent tracheomalacia complications. J Pediatr Surg 53(7):1420–1423 (Jul)

    PubMed  Google Scholar 

  20. Putnam LR, Tsao K, Lally KP, et al. Congenital Diaphragmatic Hernia Study Group and the Pediatric Surgery Research Collaborative. Minimally Invasive vs Open Congenital Diaphragmatic Hernia Repair (2017) Is There a Superior Approach? J Am Coll Surg 224(4):416–422 (Apr)

    PubMed  Google Scholar 

  21. Bishay M, Giacomello L, Retrosi G et al (2013) Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia: results of a pilot randomized controlled trial. Ann Surg 258:895–900

    PubMed  Google Scholar 

  22. Zani A, Lamas-Pinheiro R, Paraboschi I et al (2017) Intraoperative acidosis and hypercapnia during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia/tracheoesophageal fistula. Paediatr Anaesth 27(8):841–848 (Aug)

    PubMed  Google Scholar 

  23. Tan YW, Banerjee D, Cross KM et al (2018) Morgagni hernia repair in children over two decades: Institutional experience, systematic review, and meta-analysis of 296 patients. J Pediatr Surg 53(10):1883–1889 (Oct)

    PubMed  Google Scholar 

  24. Rosen R, Vandenplas Y, Singendonk M et al (2018) Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 66(3):516–554. https://doi.org/10.1097/MPG.0000000000001889

    Article  PubMed  PubMed Central  Google Scholar 

  25. Glen P, Chassé M, Doyle MA et al (2014) Partial versus complete fundoplication for the correction of pediatric GERD: a systematic review and meta-analysis. PLoS ONE 9:e112417

    PubMed  PubMed Central  Google Scholar 

  26. Zhang P, Tian J, Jing L, Wang Q et al (2016) Laparoscopic vs. open Nissen’s fundoplication for gastro-oesophageal reflux disease in children: A meta-analysis. Int J Surg 34:10–16 (Oct)

    PubMed  Google Scholar 

  27. Lei X, Ren Q, Yang Y, Bai T (2017) Outcome Evaluation of Laparoscopic and Open Nissen Fundoplication in Children—A Systematic Review and Meta-Analysis. Am Surg 1;83(1):90–97 (Jan)

    Google Scholar 

  28. Mauritz FA, van Herwaarden-Lindeboom MY, Zwaveling S et al (2014) Laparoscopic Thal fundoplication in children: a prospective 10- to 15-year follow-up study. Ann Surg 259(2):388–393 (Feb)

    PubMed  Google Scholar 

  29. Pacilli M, Davenport M (2017) Results of Laparoscopic Heller’s Myotomy for Achalasia in Children: A Systematic Review of the Literature. J Laparoendosc Adv Surg Tech A 27(1):82–90 (Jan)

    PubMed  Google Scholar 

  30. Miao S, Wu J, Lu J et al (2018) Peroral Endoscopic Myotomy in Children With Achalasia: A Relatively Long-term Single-center Study. J Pediatr Gastroenterol Nutr 66(2):257–262 (Feb)

    PubMed  Google Scholar 

  31. Aprahamian CJ, Morgan TL, Harmon CM, Georgeson KE et al (2006) U‑stitch laparoscopic gastrostomy technique has a low rate of complications and allows primary button placement: experience with 461 pediatric procedures. J Laparoendosc Adv Surg Tech A 16(6):643–649 (Dec)

    PubMed  Google Scholar 

  32. Lacher M, Yannam GR, Muensterer OJ et al (2013) Laparoscopic cholecystectomy for biliary dyskinesia in children: frequency increasing. J Pediatr Surg 48(8):1716–1721 (Aug)

    PubMed  Google Scholar 

  33. Shen HJ, Xu M, Zhu HY et al (2015) Laparoscopic versus open surgery in children with choledochal cysts: a meta-analysis. Pediatr Surg Int 31(6):529–534 (Jun)

    PubMed  Google Scholar 

  34. Ure BM, Kuebler JF, Schukfeh N et al (2011) Survival with the native liver after laparoscopic versus conventional kasai portoenterostomy in infants with biliary atresia: a prospective trial. Ann Surg 253(4):826–830 (Apr)

    PubMed  Google Scholar 

  35. Rescorla FJ, West KW, Engum SA et al (2007) Laparoscopic splenic procedures in children: experience in 231 children. Ann Surg 246(4):683–687; discussion 687–888

    PubMed  Google Scholar 

  36. Guizzetti L (2016) Total versus partial splenectomy in pediatric hereditary spherocytosis: A systematic review and meta-analysis. Pediatr Blood Cancer 63(10):1713–1722 (Oct)

    PubMed  Google Scholar 

  37. Feng S, Zhao L, Liao Z et al (2015) Open Versus Laparoscopic Inguinal Herniotomy in Children: A Systematic Review and Meta-Analysis Focusing on Postoperative Complications. Surg Laparosc Endosc Percutan Tech 25(4):275–280 (Aug)

    PubMed  Google Scholar 

  38. Babsail AA, Abelson JS, Liska D et al (2014) Single-incision pediatric endosurgical epigastric hernia repair. Hernia 18(3):357–360 (Jun)

    CAS  PubMed  Google Scholar 

  39. Adams S, Jobson M, Sangnawakij P et al (2017) Does thoracoscopy have advantages over open surgery for asymptomatic congenital lung malformations? An analysis of 1626 resections. J Pediatr Surg 52(2):247–251 (Feb)

    PubMed  Google Scholar 

  40. Goetz G, Klora M, Zeidler J et al (2019) Surgery for Pediatric Ureteropelvic Junction Obstruction-Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany. Eur J Pediatr Surg 29(1):33–38 (Feb)

    CAS  PubMed  Google Scholar 

  41. Polok M, Toczewski K, Borselle D et al (2019) Hydronephrosis in Children Caused by Lower Pole Crossing Vessels-How to Choose the Proper Method of Treatment? Front Pediatr. IEEE Trans Med Imaging 19;7:83 (Mar)

    Google Scholar 

  42. Bustangi N, Kallas Chemaly A, Scalabre A et al (2018) Extravesical Ureteral Reimplantation Following Lich-Gregoir Technique for the Correction of Vesico-Ureteral Reflux Retrospective Comparative Study Open vs. Laparoscopy. Front Pediatr 18;6:388 (Dec)

    Google Scholar 

  43. Shehata S, Shalaby R, Ismail M et al (2016) Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique): Stretching the limits for preservation of testicular vasculature. J Pediatr Surg 51(2):211–215 (Feb)

    PubMed  Google Scholar 

  44. Abouheba MAS, Younis W, Elsokary A et al (2019) Early Clinical Outcome of Staged Laparoscopic Traction Orchidopexy for Abdominal Testes. J Laparoendosc Adv Surg Tech A 29(4):531–537 (Apr)

    PubMed  Google Scholar 

  45. Locke JA, Noparast M, Afshar K (2017) Treatment of varicocele in children and adolescents: A systematic review and meta-analysis of randomized controlled trials. J Pediatr Urol 13(5):437–445 (Oct)

    PubMed  Google Scholar 

  46. Dingemann C, Petersen C, Kuebler JF et al (2013) Laparoscopic transperitoneal heminephrectomy for duplex kidney in infants and children: a comparative study. J Laparoendosc Adv Surg Tech A 23(10):889–893 (Oct)

    PubMed  Google Scholar 

  47. Lacher M, Muensterer OJ, Yannam GR et al (2012) Feasibility of single-incision pediatric endosurgery for treatment of appendicitis in 415 children. J Laparoendosc Adv Surg Tech A 22(6):604–608

    PubMed  Google Scholar 

  48. Martynov I, Lacher M (2018) Homemade Glove Port for Single-Incision Pediatric Endosurgery (SIPES) Appendectomy-How We Do It. European J Pediatr Surg Rep 6(1):e56–e58

    PubMed  PubMed Central  Google Scholar 

  49. Cundy TP, Harling L, Hughes-Hallett A et al (2014) Meta-analysis of robot-assisted vs conventional laparoscopic and open pyeloplasty in children. BJU Int 114(4):582–594

    PubMed  Google Scholar 

  50. Cundy TP, Shetty KC et al (2013) The first decade of robotic surgery in children. Journal of Pediatric Surgery 48(4):858–865

    PubMed  Google Scholar 

  51. Cave J (2018) Paediatric robotic surgery. Rev Article J Ann R Coll Surg Engl. https://doi.org/10.1308/rcsann.supp2.18

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20A, 04103, Leipzig, Deutschland

    P. Zimmermann & M. Lacher

Authors
  1. P. Zimmermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Lacher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Zimmermann.

Ethics declarations

Interessenkonflikt

P. Zimmermann und M. Lacher geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

B. Ure, Hannover

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zimmermann, P., Lacher, M. Update zur minimalinvasiven Chirurgie im Kindesalter. Monatsschr Kinderheilkd 167, 972–985 (2019). https://doi.org/10.1007/s00112-019-00773-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00112-019-00773-2

Schlüsselwörter

Keywords

Search

Navigation