Advances in minimally invasive surgery in children.

Minimal access pediatric surgery has developed more slowly than its adult counterpart for several reasons. Surgical pain and perioperative stress associated with open procedures have been underappreciated in children. Appropriately sized instrumentation was slow to develop because the focus of the marketplace was the adult. The advanced techniques required for pediatric laparoscopic procedures are associated with a relatively long learning curve. Reports documenting the safety, efficacy, and cost effectiveness of pediatric endosurgery are fueling a rapid evolution in instrumentation and minimal access procedures for children. This evolution will eventually influence most pediatric surgical procedures, changing the paradigm of the practice of pediatric surgery. It is the pediatric patient who has the most to gain from these alterations in their surgical care with less pain, decreased hospital days, and earlier return to regular activities.