Two year experience with minimal access surgery at Schneider Children's Medical Center of Israel

Background: The minimal access surgery revolution has only just begun to impact on pediatric surgery, thanks mainly to technologic advances and evidence of the benefits of minimally invasive procedures in this population. Objectives: To review the current status of MAS in a pediatric tertiary care center in Israel, in terms of feasibility, safety, and effect on standard practices. Methods: We reviewed the files of all children who underwent a MAS procedure in our department during the period April 2002 to July 2004, and compared the findings with those of children treated by standard practices. Results: A total of 301 procedures were performed in 271 patients: 107 thoracoscopic and 194 laparoscopic. There were no major intraoperative complications. The total conversion rate was 3.65%: 0 for thoracoscopy and 5.6% for laparoscopy (11/194). Twenty-four types of procedures were performed during the study period. The thoracoscopies accounted for 92.24% of all thoracic procedures in the department (107/116), and routine abdominal laparoscopic procedures replaced open surgery in 30-100% of cases (total 44.8%, 194/433). Conclusions: MAS procedures appear to be safe for a wide range of indications in children. In our center they currently account for a significant percentage of pediatric surgeries. We suggest that the integration of MAS training in the residency programs of pediatric surgeons be made a major long-term goal. The creation of a pediatric MAS study group that would allow for multi-institutional studies is especially important in Israel where a relatively large number of pediatric surgery departments handle a small annual number of patients.