title: Enthusiasm, evidence and ethics: the triple E of minimally invasive pediatric surgery.
abstract: Minimally invasive techniques are applicable in more than 60% of abdominal and thoracic operations in children. Enthusiasts promoted these techniques for many years. However, level 1 evidence on advantages of minimally invasive surgery in children remains limited. Randomized controlled trials have been conducted for some types of procedures such as laparoscopic appendectomy, fundoplication, pyloromyotomy, and inguinal hernia repair. The results of these studies confirm some advantages of minimally invasive surgery, but for most types of laparoscopic and all types of thoracoscopic procedures, such data remain to be established. This article also focuses on reports on complications and disadvantages which are relevant for final conclusions and recommendations. The ethical implications of the application of new techniques in children are also discussed. On the basis of evidence based data and ethical principles, minimally invasive techniques may be appropriately used in the future.
authors: Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. ure.benno@mh-hannover.de
authors: Benno
authors: B
authors: Ure
mesh_terms: D002648:Child; D019317:Evidence-Based Medicine; D013502:General Surgery / Q000941:ethics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000941:ethics; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000941:ethics / Q000379:methods*; D036302:Therapeutic Human Experimentation / Q000941:ethics; D035703:Therapies, Investigational; D013906:Thoracoscopy / Q000941:ethics