The minimally invasive surgery and regenerative medicine: clinical and experimental aspects

The field of pediatric surgery has undergone numerous changes throughout the past few years. First of all the laparoscopic surgery, introduced with reluctance because many of the instruments were not appropriate for their tiny patients. Finally, the often quoted benefits of smaller scars, less pain, and shorter hospital stays had not been shown to be true in the pediatric patient. However, in the mid 1990s, surgeons began to publish their laparoscopic pediatric cases, showing laparoscopy to be a potential alternative for these patients. When pediatric surgeons began to perform laparoscopic procedures on small children and neonates, they were often forced to use instruments designed for adult patients. In the mid 1990s, 2- and 3-mm instruments were developed, which allowed surgeons to work with greater ease in confined spaces. Around the same time, a neonatal insufflator was also developed. In contrast to adult insufflators, neonatal insufflators deliver CO2 in small, controlled puffs. This technology reduced the risk of over-insufflation that was often associated with using the oversized adult insufflators in small children. Over-insufflation can often be accompanied by a significant increase in end-tidal carbon dioxide, or the measurement of the amount of carbon dioxide in the expired air. If this is not adjusted for by the anesthesiologist, overinsufflation can lead to significant pulmonary complications in already fragile neonates. With these advances, more pediatric surgeons are expanding their repertoire of minimally invasive operations. Not only are they increasing the number of cases that can be performed laparoscopically, but they are also showing that they can be safely performed on neonates weighing 5 kg and less. In parallel the regenerative medicine was a relatively new field. This combining tissue engineering and cell transplantation, with the aim of replacing damaged tissues and organs using living cells. The regenerative medicine could lead to new ways of repairing or replacing injured organs, ...