title: Minimally invasive pediatric surgery: Increasing implementation in daily practice and resident's training.
abstract: BACKGROUND
  In 1998, the one-year experience in minimally invasive abdominal surgery in children at a pediatric training center was assessed. Seven years later, we determined the current status of pediatric minimally invasive surgery in daily practice and surgical training.
  
  
  METHODS
  A retrospective review was undertaken of all children with intra-abdominal operations performed between 1 January 2005 and 31 December 2005.
  
  
  RESULTS
  The type of operations performed ranged from common interventions to demanding laparoscopic procedures. 81% of all abdominal procedures were performed laparoscopically, with a complication rate stable at 6.9%, and conversion rate decreasing from 10% to 7.4%, compared to 1998. There were six new advanced laparoscopic procedures performed in 2005 as compared to 1998. The children in the open operated group were significantly smaller and younger than in the laparoscopic group (p < 0.001 and p = 0.001, respectively). The majority (64.2%) of the laparoscopic procedures were performed by a trainee. There was no difference in the operating times of open versus laparoscopic surgery, or of procedures performed by trainees versus staff surgeons. Laparoscopy by trainees did not have a negative impact on complication or conversion rates.
  
  
  CONCLUSIONS
  Laparoscopy is an established approach in abdominal procedures in children, and does not hamper surgical training.
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands. e.a.tevelde@umcutrecht.nl
authors.forename: E A
authors.initials: EA
authors.lastname: te Velde
authors.forename: N M A
authors.initials: NM
authors.lastname: Bax
authors.forename: S H A J
authors.initials: SH
authors.lastname: Tytgat
authors.forename: J R
authors.initials: JR
authors.lastname: de Jong
authors.forename: D Vieira
authors.initials: DV
authors.lastname: Travassos
authors.forename: W L M
authors.initials: WL
authors.lastname: Kramer
authors.forename: D C
authors.initials: DC
authors.lastname: van der Zee
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004066:Digestive System Diseases / Q000175:diagnosis / Q000601:surgery*; D004503:Education, Medical, Graduate; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods / Q000639:trends*; D007813:Laparotomy / Q000193:education / Q000639:trends; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000193:education / Q000639:trends*; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome