tailieunhanh - Pediatric Laparoscopy - part 7

Năm 1911, bác sĩ phẫu thuật Thụy Sĩ HC Jacobaeus báo cáo việc sử dụng nội soi ổ bụng chẩn đoán trong một số lượng lớn các bệnh nhân với một loạt các điều kiện bao gồm cả ung thư. Ít tiến bộ đã được thực hiện tuy nhiên trong phát triển vai trò của phẫu thuật truy cập tối thiểu trong bệnh ác tính trong hơn 70 năm. | Chapter 19 Minimally Invasive Surgery for Pediatric Cancer Andrew M. Davidoff Introduction In 1911 the Swiss surgeon H. C. Jacobaeus reported the use of diagnostic laparoscopy in a large number of patients with a variety of conditions including cancer. Little progress was made however in developing the role of minimal access surgery in malignant disease for over 70 years. The technologic advances in the late 1980s with the introduction of miniaturized video cameras resulted in a dramatic escalation in the use of minimally invasive surgery. Its use in patients with malignancies has been slower to evolve however but is gaining greater acceptance for use in adult cancer patients. As the general use of minimal access surgery in pediatric patients has lagged behind its use for adult patients so too has its use in infants and children with malignancies. It has not as yet been widely accepted for more than diagnostic purposes and there are only a few reports describing the use of minimal access surgery in infants and children with cancer. Several concerns have contributed to the limited use of minimal access surgery in these patients. 1 Loss of tactile sensation. This is important when trying to evaluate the thoracic or peritoneal cavities for tumor spread and lymph node involvement when for example attempting therapeutic resection of pulmonary metastases in patients with osteosarcoma or accurately staging a patient with an abdominal neuroblastoma. 2 Tumor spill. Spill of a Wilms tumor for example has a significant impact on tumor staging therapeutic approach and ultimately prognosis. In addition a number of pediatric tumors such as pleuropulmo-nary blastoma or malignant thymoma are not responsive to treatment modalities other than surgical resection. Tumor spill often leads to local recurrence that can be ultimately very difficult to treat. 3 Tumor recurrence at trocar sites. Although there are few reports of this phenomenon in adult patients pediatric surgical .