Narayana Health Care

What is the Laparoscopic or Key Hole Surgery?

It is the surgery performed by using the latest technology where instead of big cut on belly or chest, the surgery is performed using small cuts popularly known as the Key Hole Surgery.

What are the advantages of Key Hole Surgery in Children?

1. Less pain.
2. Early recovery.
3. Good aesthetic healing.
4. Decreased hospitalization.
5. Early return to school and work.

Is there any difference between Key Hole surgery in children and adults?

1. Many surgical conditions in children are different than adults.
2. The laparoscopic equipment in children consists of smaller length and diameter.
3. In children, the abdominal space to work is less and needs a surgeon experienced in paediatric laparoscopic surgery.

In which conditions the Key Hole Surgery can be performed in Children?

Key Hole surgery can be performed in most of the surgical conditions. The list of the surgeries which can be performed using this technique is as follows.

Indications of Laparoscopic Surgery

• Repair of Inguinal hernia
• Orchidopexy (Non-Palpable Undescended Testis)
• Diagnostic laparoscopy in

1. 1. chronic abdominal pain
   2. bleeding in stool
   3. intersex disorders
   4. non-palpable undescended testis
   5. Ascites due to unknown ethology

• Appendicectomy
• Single or multi-stage Laparoscopic Surgery for Hirschsprung’s disease
• Laparoscopic pull-through for Imperforate anus
• Nissen Fundoplication
• Removal of gall bladder
• Removal of spleen and kidney
• Excision of cysts in the abdomen
• Surgery for Achalasia Cardia
• Surgery for Malrotation of small bowel
• Surgery for Meckel’s diverticulum
• Abdominal lymph node biopsy
• Nephrectomy, Nephroureterectomy
• Pyeloplasty, Pyelo & Ureterolithotomy
• Ovarian surgery

Indications of Thoracoscopic Surgery

• Empyema surgery
• Lung Biopsy & Lung resection
• Excision of lung cyst
• Division of PDA and Thymectomy
• Repair of Diaphragmatic Hernia
• Repair of TEF
• Esophageal surgery

What are the contraindications of laparoscopic surgery?

1. Bleeding disorder
2. Unstable condition of a patient

Role of Key Hole Surgery in Inguinal Hernia

The commonest surgical condition in children is an inguinal hernia. This child presents with swelling in the groin, which often slides into the scrotum. The inguinal hernia should be operated within a few days of the diagnosis to prevent complications like irreducibility, obstruction, and strangulation.

The Key hole surgery can be performed using laparoscopic techniques using three mm ports. Following are the specific advantages of Key Hole surgery in inguinal hernia.

1. Ability to look on the opposite side for the defect which can lead to the formation of hernia and to repair it using the same ports under the same anesthesia; thus avoiding the second operation.
2. The key hole surgery is performed using magnification which decreases the risk of injury to vas and vessels.
3. There is minimal access to trauma.
4. There is no scrotal edema as there is no disruption of the lymphatics and venous drainage.
5. In girls, we can look at internal genital organs.

Role of Laparoscopy in Non-palpable Undescended testis

When the testis is not palpable in its normal position of scrotum or the inguinal canal then it is termed as the Non-palpable undescended testis (NPT). NPT can be either absent, atrophic or abdominal. Imaging studies like USG, CT Scan and MRI are often equivocal to locate the testis and hence they are not recommended. The best way to locate the testis is by performing laparoscopy. The testes which are in the abdomen can be brought to the scrotum by one operation if they are close to the groin and in two operations if the testis is located far from the groin. If the testis is very small in size they are removed and the opposite side is fixed to prevent the torsion related loss in the future. If the testis are absent nothing more is required except the fixing the opposite testis for the reason already mentioned.

Role of thoracoscopic surgery in empyema thoracis

Empyema is the collection of pus in the chest around the lungs. The traditional management consists of its drainage by the tube in the chest and antibiotics. However, many times by the time the child comes to the hospital, this pus is very thick and effective drainage can’t be established using the tube. In this patient, the choice is either clean up the chest cavity using open surgery or using key hole surgery. The key hole surgery is the preferred technique as the scar and pain related to the big cut can be avoided. After the key hole surgery, recovery is very fast and most of the patient can be discharged within 7 days from the hospital.

Advantages of Laparoscopic Appendicectomy over the open surgery.

The commonest gastrointestinal emergency in children is due to acute appendicitis. The patient usually has the triad of pain, vomiting, and fever in that order. Abdominal examination reveals a tender abdomen. The white cell count is raised with neutrophilia. The appendicular phlegmon is often picked up on the USG. Then the emergency laparoscopic appendicectomy is performed. The laparoscopy has all the advantage of minimally invasive surgery. The appendix is removed using three ports in more than 95 % of cases and even in very obese patients. If the appendix is found normal than through abdominal exploration can be performed through the same ports. If the appendix is burst causing pus in the abdomen then the pus can be thoroughly sucked, which can decrease the incidence of intra-abdominal abscess in such situation.

Facilities Available at SRCC Children’s Hospital managed by Narayana Health

1. Excellent Paediatric Intensive Care.
2. World Class operating rooms with excellent facilities to perform key hole surgery.
3. Experienced team of key hole surgeons and back up team of resident doctors.
4. Easily approachable from any part of the Mumbai/India by its location at Haji Ali, Mumbai.

Dr. Rasik Shah | Senior Consultant | Paediatric General and Laparoscopy children | SRCC Children’s Hospital, Mumbai