THE ANATOMY OF PEDIATRIC LAPAROSCOPIC AND THORACOSCOPIC PROCEDURES ‐ NEWER CONCEPTS AND PROCEDURES

Abstract

Laparoscopic procedures in pediatric surgery can be be divided grossly into abdominal and thoracic procedures. The basic procedures in laparoscopy require an understanding of body wall surface and muscle anatomy. Laparoscopic pediatric procedures have revolutionized the treatment of tracheo‐oesophageal fistulas with oesophageal atresia, duodenal atresia, anorectal malformations, appendicitis, hirschsrpung disease and inguinal hernias.Abdominal laparoscopy requires gas insufflation, the use of surface ports in various sites and and a keen understanding of upper and lower abdominal anatomy. Iatrogenic abdominal injuries include vascular trauma, retroperitoneal heamorrhage, bladder injuries and stomach injuries especially when it is overinflated. Most procedures use a camera port with 2 or more ports for instrumentation. Lower abdominal laparoscopies have a risk of hernias, damage to the inferior epigastric blood vessels and bowel damage. A detailed knowledge of the abdominal body wall musculature and underlying vascular structures is required. The anatomy reinforcing single port laparoscopy procedures is presented in this work too. Transuterine and cul‐de‐sac approaches are revisited and explained.Thoracospic pediatric surgical procedures have a risk of injury to the lung, pleura and thoracic wall vasculature. Newer anatomical approaches through the posterior thoracic wall ports are also proposed and explained.To correct spinal and vertebral defects newer sites of laparoscopic port entry are proposed with an eye to access and maximum utilization of small working space in such procedures.Support or Funding InformationFunding received from the Ministry of Health, Saudi Arabia and the Indian Institute of Morphology, Kolkata.