Endoscopic Surgery in Children

Springer Berlin Heidelberg New York Barcelona Hong Kong London Milan Paris Singapore Tokyo

N.M.A. Bax· K.E. Georgeson· A.S. Najmaldin . J-S. Valla (Eds.)

Endoscopic Surgery in Children With 182 figures and 13 tables

i Springer

N.M.A. Bax, MD, PhD Professor of Pediatric Surgery Department of Pediatric Surgery University Children's Hospital Utrecht The Netherlands

Keith E. Georgeson, MD Professor of Pediatric Surgery and Director of the Division of Pediatric Surgery The Children's Hospital of Alabama Birmingham Alabama USA

Azad S. Najmaldin, MS, FRCS Senior Consultant Department of Pediatric Surgery St. James's University Hospital Leeds United Kingdom

Jean-Stephane Valla, MD Professor of Pediatric Surgery and Head of the Department of Pediatric Surgery Fondation Lenval Hopital pour Enfants Nice France

ISBN -13: 978-3-642-64161-9 Springer-Verlag Berlin Heidelberg New York

Library of Congress Cataloging-in-Publication Data Endoscopic surgery in children / N.M.A. Bax ... let al.]. p. cm. Includes bibliographical references and index. ISBN-13: 978-3-642-64161-9 (alk. paper) 1. Endoscopic surgery. 2. Children--Surgery. I. Bax, N. M. A., 1944-[DNLM: 1. Surgical Procedures, Endoscopic--in infancy & childhood. WO 505 Es6 1999] RJsl.Es3Es3 1999 617.9 '8--dc21 DNLM/DLC for Library of Congress 99-10448 CIP ISBN -13: 978-3-642-64161-9 e-ISBN-13:978-3-642-59873-9 DOl: 10.1007/978-3-642-59873-9

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To all sick children of the world

Preface

Pediatric surgeons have been involved in thoracoscopy and laparoscopy since at least the end of the 1960'S (Gans and Berci 1971,1973; Klimkovich et al. 1971; Kushch and Timchenko 1969; Rosenberg and Gognat 1971; Zeidler and Vogt­Moykopf 1972). Most of the procedures at that time were diagnostic. In 1973 a laparoscopic therapeutic procedure, the removal of a broken offventriculo-peri­toneal shunt, was published by Gans and Berci (1973) and in 1979 Morgan report­ed laparoscopic-assisted placement and repair of ventriculo-peritoneal shunts (Morgan 1979). The state of the art regarding pediatric endoscopy at the begin­ning of the 1980'S is well described in Pediatric Endoscopy, edited by Gans (1983). Most of the chapters in Gans' book describe diagnostic endoscopy. During the rest of 1980'S it remained quite in the area of pediatric thoracoscopy and lapar­oscopy.

In 1990 the first publications regarding laparoscopic clipping of the testicular vessels as the first step of a Fowler-Stephens orchidopexy for intra-abdominal testis appeared (Andze et al. 1990). In 1991 a large multicenter series regarding laparoscopic appendectomy in children was published (Valla et al. 1991). Also in 1991 the first reports of more extended multichannellaparoscopic operations in children (such as cholecystectomy) appeared in the literature (Holcomb et al. 1991; Newman et al. 1991). In contrast, the first reports concerning multichannel laparoscopic cholecystectomy in adults had been published 2 years earlier (Dubois et al.1989; Reddick and Olsen 1989; Perissat et al.1989). While pediatric surgeons traditionally have been more involved in diagnostic thoracoscopy and laparoscopy than their colleagues treating adults, pediatric surgeons have lagged behind in the development of thoracoscopic and laparoscopic therapeu­tic procedures for use in children.

This book presents the current state of the art in endoscopic surgery in chil­dren. As this type of surgery in children has been developed by many colleagues from all over the world, many of these experts have been invited to contribute to this book. They have been asked not to write about what can be done, but about what has been done, and whether one should continue along these lines. The book focuses primarily on the surgical endoscopic technique. Some differences in technique may emerge as the various authors present their personal tech­niques. They may also have different views regarding indications. These differ­ences reflect the reality in medicine.

VIII Preface

Part I deals with general aspects. It begins with a general discussion on the ra­tionale of endoscopic surgery in children. General equipment and basic tech­niques are then described. One chapter is reserved for ergonomics and another for the training in and teaching of endoscopic techniques in children. Also, a chapter on anesthesia is included. Part II discusses thoracoscopic procedures, and Part III laparoscopic procedures. Each is subdivided into a section on diag­nosis and a section on therapy. Unfortunately, complications associated with en­doscopic surgery do occur, and a chapter dealing with this is included in Part III. Part IV focuses on the endoscopic approach of the urogenital tract, and Part V on the endoscopic approach of the vertebral column and of the brain. Part VI discusses the place of endoscopic surgical techniques in pediatric oncology. The book concludes with a view to the future.

The editors hope that this book fulfills a need and will help pediatric surgeons to become involved in and to advance with endoscopic surgery. It is the duty of all pediatric surgeons to think about less invasive surgical methods in treating children. The current state of endoscopic surgery is not as advanced as it should be, but at least the first steps have been taken, and they will spur on further progress.

This book could not have appeared without the support of many persons and institutions, principal of whom are those at Springer-Verlag. We are also very grateful to our artist, Ingrid Janssen, from the Audiovisual Department, Univer­sity of Utrecht, The Netherlands, for her excellent restyling of the drawings. We are indebted to Karl Storz for the financial support in producing the figures.

N.M.A.Bax K.E. Georgeson A.S. Najmaldin J-S. Valla

Preface IX

References

Andze GO et al (1990) La place de la laparoscopie therapeutique dans Ie traitment des test­icules intra-abdominaux chez l'enfant Chir Pediatr 31: 299-302

Dubois F, Berthelot G, Levard H (1989) Cholecystectomie par coelioscopie. Presse Med 18:980-982

Gans L, Berci G (1971) Advances in endoscopy of infants and children. J Pediatr Surg 6: 199-233 Gans L, Berci G (1973) Peritoneoscopy in infants and children. J Pediatr Surg 8:399-405 Gans SL (1983) Pediatric endoscopy. Grune and Stratton, New York Holcomb III GW, Olsen DO, Sharp KW (1991) Laparoscopic cholecystectomy in the pediat-

ric patient. J Pediatr Surg 26: 1186-1190 Klimkovitch IG et al (1991) Torakoskopiia u detei. Khirurgiia Mosk 47: 19-24 Kushch NL, Timchenko AD (1969) Laparoskopiia u detei. Vestn Khir 102:92-94 Morgan WW (1979) The use of peritoneoscopy in the diagnosis and treatment of complica­

tions ofventriculoperitoneal shunts in children. J Pediatr Surg 14:18-181 Newman KD et al (1991) Laparoscopic cholecystectomy in pediatric patients. J Pediatr Surg

26: 1184-1185 Perissat J, Collet DR, Belliard R (1989) Gallstones: laparoscopic treatment, intracorporeal

lithotripsy by cholecystostomy or cholecystectomy - a personal technique. Endoscopy 21 Suppl1 : 373-374

Reddick EJ, Olsen DO (1989) Laparoscopic laser cholecystectomy. A comparison with mi­nilap cholecystectomy. Surg Endosc 3: 131-133

Rosenberg D, Gognat M (1971) La coelioscopie dans l'enfance et l'adolescence. Gynecol Pract 22: 531-539

Valla JS et al. (1991) Appendicectomies chez l'enfant sous coelioscopie operatoire. 465 cas. J Chir Paris 128: 306-312

Zeidler D. Vogt-Moykopf I (1972) Die Endoscopie im Thoraxbereich beim Kind. Med Klin 67: 660-664

Preface

Pediatric surgeons have been involved in thoracoscopy and laparoscopy since at least the end of the 1960'S (Gans and Berci 1971,1973; Klimkovich et al. 1971; Kushch and Timchenko 1969; Rosenberg and Gognat 1971; Zeidler and Vogt­Moykopf 1972). Most of the procedures at that time were diagnostic. In 1973 a laparoscopic therapeutic procedure, the removal of a broken offventriculo-peri­toneal shunt, was published by Gans and Berci (1973) and in 1979 Morgan report­ed laparoscopic-assisted placement and repair of ventriculo-peritoneal shunts (Morgan 1979). The state of the art regarding pediatric endoscopy at the begin­ning of the 1980'S is well described in Pediatric Endoscopy, edited by Gans (1983). Most of the chapters in Gans' book describe diagnostic endoscopy. During the rest of 1980'S it remained quite in the area of pediatric thoracoscopy and lapar­oscopy.

In 1990 the first publications regarding laparoscopic clipping of the testicular vessels as the first step of a Fowler-Stephens orchidopexy for intra-abdominal testis appeared (Andze et al. 1990). In 1991 a large multicenter series regarding laparoscopic appendectomy in children was published (Valla et al. 1991). Also in 1991 the first reports of more extended multichannellaparoscopic operations in children (such as cholecystectomy) appeared in the literature (Holcomb et al. 1991; Newman et al. 1991). In contrast, the first reports concerning multichannel laparoscopic cholecystectomy in adults had been published 2 years earlier (Dubois et al.1989; Reddick and Olsen 1989; Perissat et al.1989). While pediatric surgeons traditionally have been more involved in diagnostic thoracoscopy and laparoscopy than their colleagues treating adults, pediatric surgeons have lagged behind in the development of thoracoscopic and laparoscopic therapeu­tic procedures for use in children.

This book presents the current state of the art in endoscopic surgery in chil­dren. As this type of surgery in children has been developed by many colleagues from all over the world, many of these experts have been invited to contribute to this book. They have been asked not to write about what can be done, but about what has been done, and whether one should continue along these lines. The book focuses primarily on the surgical endoscopic technique. Some differences in technique may emerge as the various authors present their personal tech­niques. They may also have different views regarding indications. These differ­ences reflect the reality in medicine.

Contents

Part I Basics

Why Endoscopic Surgery in Children? N.M.A. Bax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Instrumentation K.B. Georgeson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Basic Technique A.S. Najmaldin, D. Grousseau . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Ergonomics of Task Performance in Endoscopic Surgery G.B. Hanna, C. Kimber, A. Cuschieri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Training in Paediatric Endoscopic Surgery A.S. Najmaldin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Basic Physiology and Anesthesia M. SJez...................................................... 53

Part II Chest Thoracoscopy in Infants and Children: Basic Technique

S.S. Rothenberg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Diagnostic Thoracoscopy in Children

B.M. Rodgers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Thoracoscopy in the Treatment of Empyema in Children

B.M. Rodgers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Therapeutic Thoracoscopic Procedures in Children:

Indications and Surgical Applications in Lung and Mediastinum /-L. Michel, Y. Revillon. . . .. . . . . . . . . .. . . . . . . . . . .. . . . . .. . . . . . . . . . 98

Thoracoscopic Repair of Hiatal Hernia in Children S.S. Rothenberg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Closure of Patent Ductus Arteriosus F. Laborde, T. Folliguet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Vascular Access N.M.A. Bax, D.C. van der Zee................................... 121

Endoscopic Transthoracic Sympathectomy in the Treatment of Primary Palmar Hyperhidrosis in Children G. Lotan, 1. Vinograd. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Video-Asssisted Repair of Esophageal Atresia M. Robert, H. Lardy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Contents XIII

Liver and Biliary Tree

Endoscopic Surgery for Liver Hydatid Cysts F./. Berchi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291

Laparoscopic Cholecystectomy G. W. Holcomb III. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

Spleen

Laparoscopic Splenectomy w.R. Thompson, E. Parra-Davila. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311

Diaphragm

Laparoscopic Repair of Diaphragmatic Conditions in Infants and Children D.G. van der Zee, N.M.A. Bax, I-So Valla. . . . . . . . . . . . . . . . . . . . . . . . . . 323

Inguinal Hernia

Contralateral Groin Exploration During Inguinal Hernia Repair K.E. Georgeson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331

Shunts and Catheters

Laparoscopic Approach to Ventriculoperitoneal Shunts N.M.A. Bax, D.G. van der Zee, w.P. Vandertop. . . . . . . . . . . . . . . . . . . . . 337

Laparoscopic Insertion of Peritoneal Dialysis Catheters in Children C.K. Yeung, K. F. Yip. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344

Complications

Complications in Laparoscopic Surgery in Children N.M.A. Bax, D.G. van der Zee................................... 357

Part IV Urogenital Tract Transperitoneal Laparoscopic Nephrectomy

A.S. Najmaldin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371 Video surgery of the Retroperitoneal Space in Children

I-So Valla .................................................... 379 The Nonpalpable Testis

F. Ferro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 Laparoscopic Varicocele

G.A. MacKinlay ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408 Adnexal Pathology

H. Steyaert, Y. Heloury, V. Plattner, I-So Valla. . . . . . . . . . . . . . . . . . . . . . 415 Laparoscopy and Intersex

Y. Heloury, V. Plattner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427

XIV

Part V Orthopedics and Neurosurgery Thoracoscopic Anterior Spinal Diskectomy and Fusion

Contents

G. W. Holcomb III ............................................ 433 Indications, Techniques and Results of Pediatric Neuroendoscopy

I.A. Grotenhuis, w.P. Vandertop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443

Part VI Oncology Endoscopic Surgery in Paediatric Oncology

H.A. Steinbrecher, A.S. Najmaldin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465

Part VII Conclusion The Future of Endoscopic Surgery in Children

K.B. Georgeson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477

Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481

Contributors

Jean Luc Alain, MD Professor of Pediatric Surgery and Head of the Department of Pediatric Sur­gery, University of Limoges School of Medicine, University Dupytren Hospi­tal, Limoges, France

Klaas(N) M.A. Bax, MD, PhD Professor of Pediatric Surgery, Department of Pediatric Surgery, University Children's Hospital, Utrecht, The Netherlands

Daniel A. Beals, MD Division of Pediatric Surgery, The University of Alabama at Birmingham, The Children's Hospital of Alabama, Birmingham, USA

Francisco J. Berchi, MD Professor of Pediatric Surgery and Head of the Department of Pediatric Sur­gery, Hospital Materno Infantil 12 de Octubre, University of Compultense, Madrid, Spain

Piero Buffa, MD Department of Pediatric Surgery, Giannina Gaslini Institute, University of Genoa, Genoa, Italy

Aldo Cagnazzo, MD Department of Pediatric Surgery, Giannina Gaslini Institute, University of Genoa, Genoa, Italy

Guillaume Cargill, MD Department of Pediatric Surgery, Hopital Necker-Enfants Malades, Paris, France

Alfred Cuschieri,MD, ChM, FRCSEd, FRCSEng, FRCSGlas (Hon), FIBiol Professor of Surgery, Ninewells Hospital and Medical School, Dundee, Scot­land

Fabio Ferro, MD Department of Pediatric Surgery and Urology, Bambino Gesu Children's Hos­pital, Rome, Italy

Thierry Folliguet L'Institut Mutualiste Montsouris, Paris, France

Keith E. Georgeson, MD Professor and Director, Department of Surgery, Division of Pediatric Surgery, The University of Alabama at Birmingham, The Children's Hospital of Ala­bama, Birmingham, USA

XVI Contributors

J. Andre Grotenhuis, MD Senior Consultant, Department of Neurosurgery, Academic Hospital Nijmeg­en, Nijmegen, The Netherlands

Dominique Grousseau, MD Senior Consultant, Department of Pediatric Surgery, University Dupytren Hospital, Limoges, France

George B. Hanna, MD Consultant, Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland

Yves Heloury, MD Professor of Pediatric Surgery, Department of Pediatric Surgery, Centre Hos­pitalier Universitaire de Nantes, H6pital Mere et Enfant, Nantes, France

George W. Holcomb, III, MD Associate Professor of Surgery, Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Gill M.E. Humphrey, MB, ChB, MD Senior Registrar in Pediatric Surgery, Leeds United Teaching Hospitals, St. James's University Hospital, Leeds, United Kingdom

Ingrid Janssen, illustrator, Audiovisual Department, University of Utrecht, The Netherlands

Vincenzo Jasonni, MD Professor of Pediatric Surgery, Department of Pediatric Surgery, Giannina Gaslini Institute, University of Genoa, Genoa, Italy

Chris Kimber Research Fellow, Surgical Skills Unit, Ninewells Hospital and Medical School, Dundee, Scotland

Franl;ois Laborde, MD L'Institut Mutualiste Montsouris, Paris, France

Hubert Lardy, MD Consultant, Department of Pediatric Surgery, Centre Hospitalier Universi­taire, Clocheville, Tours, France

Gad Lotan, MD Department of Pediatric Surgery, "Assaf Harofeh" Medical Center, Zerifin, Israel

Gordon A. Mackinlay, MB, BS, LRCP, FRCS(Ed), FRCS Senior Lecturer in Clinical Surgery, University of Edinburgh; Consultant Pae­diatric Surgeon, The Royal Hospital for Sick Children, Edinburgh, Scotland

Girolamo Mattioli, MD Department of Pediatric Surgery, Giannina Gaslini Institute, University of Genoa, Genoa, Italy

Jean-Luc Michel, MD Department of Pediatric Surgery, H6pital Necker-Enfants Malades, Paris, France

Philippe Montupet, MD Department of Pediatric Surgery, H6pital Necker-Enfants Malades, Paris, France

Contributors XVII

Azad S. Najmaldin, MS, FRCS Senior Consultant, Department of Paediatric Surgery, St. James's University Hospital, Leeds, United Kingdom

Eduardo Parra-Davila, MD Chief Resident, Department of General Surgery, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA

Veronique Plattner, MD Senior Consultant, Department of Pediatric Surgery, Centre Hospitalier Uni­versitaire de Nantes, Hopital Mere et Enfant, Nantes, France

Yann Revillon, MD Professor of Pediatric Surgery, Department of Pediatric Surgery, Hopital Necker-Enfants Malades, Paris, France

Michel Robert, MD Professor of Pediatric Surgery and Head of the Department of Pediatric Sur­gery, Centre Hospitalier Universitaire, Clocheville, Tours, France

Bradley M. Rodgers, MD University of Virginia Health System, Department of Pediatric Surgery, Divi­sion of Pediatric Surgery, Charlottesville, Virginia, USA

Steven S. Rothenberg, MD Assistant Clinical Professor of Surgery, University of Colorado, Director of Pediatric Surgery, Columbia Presbyterian/St Luke's Medical Center, Denver, Colorado, USA

Felix Schier, MD Professor of Pediatric Surgery and Head of the Department of Pediatric Sur­gery, Friedrich-Schiller University Hospital, Jena, Germany

Michel S!ez, MD Senior Consultant Anesthetist, Paris, France

Henrik A. Steinbrecher, MS, FRCS Consultant, Department of Pediatric Surgery, Wessex Regional Centre for Paedi­atric Surgery, Southampton General Hospital, Southampton, United Kingdom

Henri Steylaert, MD Senior Consultant, Department of Pediatric Surgery, Fondation Lenval, Hopi­tal pour Enfants, Nice, France

W. Raleigh Thompson, MD Associate Professor of Surgery, Chief Division of Pediatric Surgery, University of Miami School of Medicine, Miami, Florida, USA

Jean-Stephane Valla, MD Professor of Pediatric Surgery and Head of the Department of Pediatric Sur­gery, Fondation Lenval, Hopital pour Enfants, Nice, France

David C. van der Zee, MD, PhD Senior Consultant, Department of Pediatric Surgery, University Children's Hospital, Utrecht, The Netherlands

W. Peter Vandertop, MD, PhD Senior Consultant, Department of Neurosurgery, University Hospital and University Children's Hospital, Utrecht, The Netherlands

XVIII Contributors

Itzhak Vinograd, MD Department of Pediatric Surgery, "Assaf Harofeh" Medical Center, Zerifin, Israel

/urgen Waldschmidt, MD Professor of Pediatric Surgery and Head of the Department of Pediatric Sur­gery, University Hospital Benjamin Franklin, Berlin, Germany

Chung Kwong Yeung, MD, FRCS, FRACS, DCH Professor of Pediatric Surgery and Head of the Department of Pediatric Sur­gery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Republic of China

Kam-Fai Yip, MD Senior Consultant, Department of Pediatric Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Republic of China