The Role of Laparoscopy in Pediatric Abdominal Malignant Tumors presented by Gustavo Stringel, MD, MBA & Cancer and Laparoscopy: Pearls and Pitfalls presented by Stephen Kavic, MD
Laparoscopy in the pediatric patient can be used for biopsy, resection, and to evaluate the need for resection. Malignant tumors occur in 1 to 2 of every 10,000 patients less than 15 years of age.
One-third are solid tumors, neuroblastoma, Wilm’s tumor, and other renal tumors. Because tumors are manipulated more with laparoscopy than with open surgery, patients must be pretreated. The role of laparoscopy continues to expand, but the rules that apply to open surgery must be followed because of the inability to feel the extent or fixation of tumors. However, superior visualization with magnification of the field may outweigh this drawback.
Training for minimally invasive surgeons and surgical oncologists is different. Fellowship tracks are different, and the surgical practices are different. However, in actuality all surgeons are oncologists—incidental oncologists. Occasionally, a general surgeon or surgical gynecologist will come across a metastasis when performing a surgery for an unrelated condition. A laparoscopist can manage oncologic problems. However, laparoscopy is not all the same. Instruments have different sizes and number of ports needed is different. Laparoscopy is good in trained hands just as open surgery is good in trained hands. Judgment is more important than technical skills when managing an unexpected oncological problem. Conversion may impact survival.