The Transition from Open to Minimal Access Pediatric Surgery

摘要

FigureDear Friends, The transition from open to minimal access surgery (MAS) has happened over the decades. The MAS equipment and techniques have evolved over the entire century.[1,2] There are several people, many known and some unknown, who have contributed to its progress to the present state. Thus, it would be unfair to credit a single person with all the development in the field of MAS. This Editorial highlights the significant milestones in MAS and in particular Minimal Access Pediatric Surgery (MAPS) at the national (global) and personal level. Endoscopy preceded laparoscopic surgery by many years. In 1902, Georg Kelling from Dresden, Germany, performed the first laparoscopic surgery on a dog. In 1910, Hans Christian Jacobaeus from Sweden used the MAS approach to operate on a human. Kalk (1929), a German physician, introduced the forward oblique (135°) viewing lens systems; he advocated the usage of a separate puncture site for induction of pneumoperitoneum. John C. Ruddock (1934), an American surgeon, described laparoscopy as an advantageous diagnostic method. He considered it superior to an exploratory laparotomy. John C. Ruddock used an instrument consisting of built-in forceps with electrocoagulation capacity for diagnostic laparoscopy. Boesch of Switzerland is credited with the performance of the first laparoscopic tubal sterilization (1936). János Veres of Hungary developed a specially designed, spring-loaded needle (1938) to facilitate carboperitoneum. The rigid rod lens system was invented in 1953 by Professor Harold Hopkins, a British physicist who was nominated twice for the Nobel Prize. Kurt Semm, a German gynecologist, invented the automatic insufflator (1960). H. Coutnay Clarke was the first to employ a laparoscopic suturing technique for hemostasis (1972). Dekok performed the first laparoscopically-assisted appendectomy by exteriorizing the appendix and ligating it outside (1977). Kurt Semm devised the first use of endoloop for ligating structures in laparoscopic surgery (1977). He also performed the first laparoscopic appendectomy (1983). In 1985, Erich Mühe performed the first documented laparoscopic cholecystectomy in Germany. The introduction of the computer chip television camera was an indispensable event in the development of laparoscopy. The procedure could then be performed while viewing a projected image of the abdominal contents. It also provided a magnified view of the internal anatomy. These collectively allowed free movement of the surgeon's hands, making it easier to perform complex procedures. Before the use of the camera system, the MAS approach was reserved only for diagnostic purposes and a few gynecological procedures such as tubectomy. In 1987, the French physician Mouret performed the first laparoscopic cholecystectomy, using the camera on a human. The advantages of laparoscopic cholecystectomy led to its rapid acceptance by the general population. Many surgeries now use the principles of MAS. The MAS has been foremost among the surgical innovations of the 20th century. In 1971, Stephen Gans published “Advances in Endoscopy of Infants and Children” as a peritoneoscopy. The development of MAS in adults due to the innovation of camera chips paved the way for the performance of MAPS. Initially, only a handful of surgeons used this approach. These helped create a positive impact on the acceptance of laparoscopy: advances in the camera system, development of miniature hand instruments, understanding physiological effects of carboperitoneum in children, improvement in the anesthetic technique, etc. Perhaps, the most critical factor was the acceptance of MAPS by the patients and parents. This motivated surgeons to learn MAPS and adapt to the challenges. A fear of “missing the train” and potential loss of practice played an important role in motivating the surgeons to learn MAPS. This phenomenon was more prevalent in private practice as compared to public institutions. It took longer for the