1. Miniature Access Surgery in Children

2. Types of MAS Endoscopy Vaginal hysterectomy Vascular access Transurethral resection of the prostate Percutaneous endoscopic gastrostomy Angiography and angioplasty Arthroscopy Laparoscopy and thoracoscopy (1987: 1 st Laparoscopic Cholecystectomy)

3. Historical Resistance to Pediatric MAS “Children don’t experience pain.” “We already use small incisions anyway.” “Laparoscopy is only of cosmetic value.” “Laparoscopic cases don’t really apply to children.” “Just because we can do it, should we?” “It’s too expensive.” “We don’t have small enough equipment.” “It’s too hard to do, and too hard to learn.” “The cases take too long to set up, and to do.” A little history: Concept of asepsis took 20 years to be accepted

4. Smaller wounds Fewer pulmonary complications Shorter stays in the hospital Quicker return to home Quicker return to school Quicker return to unrestricted activities Parents return quicker to work Smaller wounds Fewer pulmonary complications Shorter stays in the hospital Quicker return to home Quicker return to school Quicker return to unrestricted activities Parents return quicker to work Pediatric Miniature Access Surgery Advantages

5. Here is the Laparoscopic’s Analgous Bottle in Which to Build that Ship

6. Pediatric MIS Applications

7. Appendectomy

8. Mesoappendix

9. Appendectomy, continued

10. Stapling the Mesoappendix

11. Stapling the appendiceal base

12. Splenectomy

15. Accessory Spleens

16. Stapling the Splenic Hilum

17. Splenic Cyst

18. Cholecystectomy

19. Transecting the Cystic Duct

20. Mobilizing the Gallbladder

21. Hirschsprung Disease

23. Laparoscopic Mobilization of the Rectosigmoid

24. Hirschsprung Disease Incisionless Pull through: Mucosectomy

25. Hirschsprung Disease Incisionless Pull through: Pull through & Anastomosis

26. Pectus Excavatum

28. PECTUS EXCAVATUM Miniature Access Pectus Repair

31.  Pre-Op Post-Op 

32. Nephrectomy and Donor Transplant Nephrectomy

33. Nephrectomy for Polycystic Disease

34. Transplant Donor Nephrectomy

35. Thoracoscopy

37. Heller myotomy

40. Operations on the Ovary

41. Ovarian Cyst in a 10 month old

45. Laparoscopy in a patient with Gastrointestinal Bleeding

51. Nissen Fundoplication

52. The Nissen Fundoplication

53. Suturing the Wrap

55. One month after a laparoscopic Nissen Fundoplication

56. Pyloromyotomy

57. Hypertrophic Pyloric Stenosis Open Pyloromyotomy Antrum Pylorus

58. The Pyloric Olive

59. Pyloromyotomy

60. “Old School”

61. One month follow-up after laparoscopic Pyloromyotomy