Hock Lim Tan

I12 Laparoscopic Appendectomy

We describe the conventional laparoscopic appendectomy which, in our hands, has proven to be suitable for appendicitis of all grades of severity, regardless of whether the appendix is high retrocaecal in position.

I22 Retroperitoneoscopic Nephrectomy

There are fewer indications for nephrectomy in children than in adults. These include non or minimally functioning kidneys due to congenital renal dysplasia/hypoplasia, end stage reflux nephropathy, pelvic ureteric junction obstruction and non involuting multicystic dysplastic kidney.

I2 Complications of Laparoscopic Surgery

The true incidence of complications in paediatric laparoscopy is only now becoming apparent. Gans in 1973 reported 300 cases of laparoscopy without complications in children. While the advantages of Minimally Invasive Surgery such as less physical trauma, reduction in debility, quicker recovery and other advantages have been extolled by enthusiasts, it should be noted that paediatric Minimal Invasive Surgery is not without its complications.

I27 Laparososcopic Repair of Duodenal Atresia

The laparoscopic repair of Duodenal atresia was first reported by Ure and Bax in 2001, followed by reports from Rothenberg and Holcomb, who described the use of “U” clips instead of using conventional suturing. Since then there has been sporadic reports of this operation. It is a technically challenging operation and requires considerable dexterity in being able to operate within a confined space requiring the surgeon to understand the ergonomics and be very adept at performing 5/0 intracorporeal anastomosis.

I29 Management of Upper Urinary Tract Calculi

Renal calculi are rare in children and accounts for about 1–3 percent of all patients presenting with urinary calculi. Unlike in adults where the great majority of stones are idiopathic, it is not uncommon to find an infective, or metabolic cause. An underlying anatomical abnormality may also predispose to the formation of calculi, particularly if the patient has had a proteus urinary tract infection. Bladder stones are particularly prevalent in children following bladder augmentation. Infective calculi are usually soft, containing organic matrix, and may be poorly opacified.

I26 Laparoscopic-Assisted Insertion of a Peritoneal Dialysis Catheter

Peritoneal dialysis is an alternative to haemodialysis and is used to treat patients with end-stage renal disease. Different techniques have been developed for catheter placement. We describe a single-port laparoscopic technique which allows good visualization of the pelvis and accurate positioning of the peritoneal catheter, with a low complication rate and excellent cosmetic result.

I11 Laparoscopic pyloromyotomy

Laparoscopic pyloromyotomy is an uncomplicated operation but it requires meticulous attention to detail. Only 3 hand instruments are required for this operation.

I10 Laparoscopic Fundoplication

Laparoscopic fundoplication is one of the most common elective laparoscopic procedures in childhood. The indications for laparoscopic fundoplication are similar to those for the openprocedure and include failure of medical therapy in children with symptomatic gastroesophageal reflux disease (GERD). Childrens with GERD can present with digestive (recurrent vomiting, failure to thrive, oesophagitis, peptic stricture) or respiratory symptoms (apnea, aspiration pneumonia, apparent life threatening events – ALTE). In addition GERD often required surgical correction in neurologically impaired children or in children previously operated for oesophageal atresia, congenital diaphragmatic hernia or abdominal wall defects.

I21 Laparoscopic Inguinal Herniotomy

Indirect inguinal hernias are some of the commonest surgical conditions in infancy, and while there is debate as to whether conventional or open inguinal hernia repair is the preferred option, there is now an established role for laparoscopic inspection of the contralateral internal ring to exclude an open internal inguinal ring. In neonates with an undescended testis and a hernia, laparoscopic closure of the internal ring is an indication par excellence, as it leaves the contents of the inguinal canal – including the testis – completely untouched, making subsequent orchidopexy much easier.

I23 Retroperitoneoscopic Partial Nephrectomy

Indications for partial nephrectomy in children include a dysplastic nonfunctioning upper moiety associated with a ureterocele or an ectopic ureter, or a high grade vesico-ureteric reflux in a poorly functioning lower moiety. For partial nephrectomy our preference is the prone retroperitoneal approach (PR), as it avoids entering the peritoneal cavity and provides excellent access to the renal vessels. We also describe the lateral retroperitoneoscopic approach (LR), that compared to PR creates more space inferomedially and gives better access to the lower pole or to an ectopic pelvic kidney and allows for a complete ureterectomy in all cases.