Evolution of minimally invasive techniques in pediatric surgery: a systematic review

Abstract

This study addresses the evolution of pediatric minimally invasive surgery (MIS), highlighting its benefits, such as faster recovery, less trauma, and better aesthetics, as well as the need for specific tools due to the particularities of pediatric anatomy. The use of laparoscopy in children has proven effective in reducing hospital stays and improving clinical outcomes, despite technical challenges. The introduction of robotic surgery has brought new possibilities, with notable advances in pediatric urology, gastroenterology, and gynecology, allowing for greater precision in complex procedures. The systematic review analyzed advances in MIS in pediatrics over the past 20 years, evaluating surgical interventions, postoperative management, and technological innovations. Of the initial 150 studies, 25 were fully reviewed, resulting in the selection of 5 studies that best aligned with the research objectives. These studies analyzed the clinical impact of MIS, identifying trends and gaps, such as the need for more data to validate the effectiveness of new approaches. The results indicate that techniques like microlaparoscopy and robotic surgery have enabled less invasive surgeries, with fewer complications and shorter recovery times. However, despite the advances, there is a need for more robust clinical studies to validate the safety and effectiveness of these techniques, especially in promising areas such as fetal surgery. In addition to the technical aspects, the study also emphasizes the importance of adequate surgeon training. Realistic anatomical models and technologies like 3D printing have proven useful in training new generations of surgeons. Non-pharmacological alternatives, such as the use of humanoid robots to reduce preoperative anxiety in children, were also highlighted. Although the future of pediatric MIS seems promising, barriers such as the high cost of equipment and the lack of adequate training, especially in countries like Brazil, still limit its widespread implementation. Overcoming these obstacles is crucial to ensure that MIS is widely adopted, providing better clinical outcomes for pediatric patients.