Maulana Azad Medical College and L. N. Hospital, New Delhi – 110 001, India

Children's solid tumour management requires a thorough multimodality protocol-based treatment approach. The alternative that is still often used today and in the majority of facilities is open surgical removal of tumours that develop in any region, including the belly, thorax, chest wall, HFN (head, face, and neck), brain, and extremities. However, with the development of science and technology, as well as the growing knowledge and use of laparoscopy in children, its use has expanded to include the treatment of solid tumours in children. This article attempts to review the breadth of such an intervention as well as the restrictions of minimally invasive surgery in this area of paediatric surgery.

Keywords: Limitations, solid tumours, minimally invasive surgery, and indications

In 1911, the Swiss specialist HC Jacobaeus detailed the utilization of symptomatic laparoscopy in countless patients with different circumstances including cancer.[1] Be that as it may, little headway was made in fostering the job of negligible obtrusive medical procedure (MIS) in threatening illness for north of 70 years. The technologic propels in the last part of the 1980s with the presentation of scaled down camcorders brought about an emotional heightening in the utilization of MIS. Its utilization in patients with malignancies has been more slow to advance; nonetheless, it is acquiring more noteworthy acknowledgment for use in grown-up disease patients. MIS is presently regularly utilized for some applications in grown-up careful oncology, remembering biopsy and resection of threatening illness for the chest and stomach depressions, mediastinal and retroperitoneal lymph hub analyzation, organizing of stomach, pelvic and thoracic malignancies, and the board of restorative entanglements.

As the general utilization of MIS in pediatric patients has falled behind its utilization for grown-up patients, so has been its utilization in babies and kids with malignancies. It has not, at this point, been broadly acknowledged for more than symptomatic purposes and there are a couple of reports depicting the utilization of ablative MIS in babies and kids with strong growths. There are doubters even today who feel that laparoscopy is certainly not a total type of laparotomy and that it could bring about a lacking or improper administration due to misdiagnosis.[2]

The fundamental worries that have added to the restricted utilization of negligible access a medical procedure in these patients incorporate the accompanying. Loss of material sensation: This is significant while attempting to assess the thoracic or peritoneal holes for growth spread and lymph hub contribution when, for instance, endeavoring restorative resection of pneumonic metastases in patients with osteosarcoma, or precisely organizing a patient with a stomach neuroblastoma. Cancer spill: Spill of a Wilms' growth, for instance, fundamentally affects cancer organizing, remedial methodology and, at last, visualization. Likewise, various pediatric growths, for example, pleuro-pneumonic blastoma or harmful thymoma, are not receptive to treatment modalities other than careful resection. Growth spill frequently prompts neighborhood repeat that can be at last truly challenging to treat.

Cancer repeat at trocar locales: Despite the fact that there are not many reports of this peculiarity in grown-up patients, pediatric careful oncologists keep on being worried about this issue,[3] regardless of none of the reports experiencing port site repeat (PSR).[4] Expulsion of growth examples from the stomach or thoracic holes: to hold the advantages of the negligible access approach, examples are frequently morcellated so they can be taken out through the more modest cuts. In spite of the fact that it has been shown that the utilization of a tissue morcellator doesn't impede sufficient histologic assessment of the tissue,[5] concerns remain, particularly as to the capacity to survey the edges of resection and gross anatomic relationships.[6]

Cancer size, edges and renal vein contribution can't be evaluated once Wilms' growth is morcellated.[7,8] By and by, as innovation proceeds to progress and the ability and solace of pediatric specialists with negligibly intrusive methodologies increment, its utilization for kids with malignant growth is likewise liable to increment. The general advantages of a negligibly obtrusive methodology, for example, restorative appearance, diminished emergency clinic stay, quicker recuperation, no/insignificant entrail grips, substantially less torment and uneasiness, decreased pain relieving prerequisite, negligible postoperative handicap, more limited length of postoperative ileus and fast twisted mending are important in these youngsters with cancers who by and large need long haul treatment.[9,10] A genuine model is the job of MIS in administration of kids with osteogenic sarcomas, who might go through different strategies for resectable lung metastases.

There have been numerous reports from around the world since 1971, when Klimkovich et al.[11] first described the use of thoracoscopy in children for the diagnosis of mediastinal masses and cysts, as well as masses of pulmonary parenchyma. These reports have solidified the use of MIS in the surgical management of solid tumours in children. [12–21] Robotic surgery, the most recent addition to MIS, offers a further benefit in the treatment of children with solid tumours of any age, as revealed in a retrospective analysis of 100 consecutive cases. [22] Below is a list of the many MIS indications and benefits now available for paediatric extra-cranial solid tumours.

The majority of the extracranial, strong growths of earliest stages and youth are treated with a multimodal approach. The treatment worldview for enormous growths as a rule starts with an underlying biopsy with resulting deferred essential resection. Subsequently, biopsy of another mass in a youngster either by a laparoscopic or thoracoscopic approach is a typical sign. These can frequently likewise be drawn nearer by a radiographically directed percutaneous biopsy, albeit direct representation of the injury frequently gives extra anatomic detail and may give visual affirmation of sufficient hemostasis. Also, with the ongoing expanding accentuation on the acquisition of growth tissue for biologic investigations, the laparoscopic or thoracoscopic approach might be progressively preferred for its capacity to get more tissue while remaining insignificantly intrusive.

The analytic precision for negligible access techniques has commonly been high, by and large being accounted for in the scope of 85-100 percent. The evasion of huge entry points that frequently prompted postoperative ileus and atelectasis, related to this high symptomatic exactness allowing the brief commencement of suitable chemotherapy, is a critical benefit. Likewise, decreased intraperitoneal and intrathoracic grips after an insignificantly obtrusive biopsy might be profitable while performing second look or postponed essential medical procedure. A special case for this methodology of biopsy of enormous cancers is Wilms' growth, wherein transabdominal biopsy causes inescapable growth spill into the peritoneal depression subsequently upstaging the illness.

Growths in the beginning phases can be extracted by MIS, for instance, neuroblastoma, Wilms' cancer, and so on. A few articles report laparoscopic extraction of neuroblastoma, which guarantee predominance over regular surgeries in early recuperation and capacity to start chemotherapy not long after medical procedure. However there are explicit pre-requirements for laparoscopic extraction of neuroblastoma, there is an unmistakable and distinct job of MIS in extracting these growths in children.[23-30] Nephrectomy for Wilms' cancer is one more typical medical procedure acted in youngsters. With preoperative chemotherapy, nephrectomy is conceivable utilizing MIS and intraperitoneal morcellation of cancer may not be needed.[31] A few different growths totally extracted by laparoscopy detailed in writing incorporate adrenal tumors,[32-35] Altman tpe II-IV sacrococcygeal teratomas,[36] presacral ganglioneurofibroma[37] and ovarian teratomas (oophorectomy).[38-40]

The resection of pheochromocytoma and, surprisingly, those emerging from an extra-adrenal site laparoscopically[34] demonstrates that pediatric careful oncology MIS has progressed and is tracking down an ever increasing number of signs of its utilization. One more leap forward in MIS in pediatric oncology has been resection of liver cancers in children.[41-43] Not very many reports are accessible, yet the chance of such a significant medical procedure being done laparoscopically is energizing, gave the choice standards to its utilization are met to guarantee a fruitful result. MIS resection of osteoid osteoma of long bones is one more milestone in the field of MIS in pediatric oncology, without bone joining or inside obsession, brilliant corrective appearance, early assembly and no perioperative complications.[44]

Despite the fact that there have been critical upgrades in the radiographic evaluation of the degree of threat, disparities among radiographic and careful organizing can happen. With the turn of events and acknowledgment of MIS might come a more noteworthy accentuation on the requirement for careful/pathologic organizing. Precise arranging will turn out to be considerably more significant as pediatric conventions endeavor to diminish the power of treatment, while keeping up with high paces of fix right now accomplished for the overwhelming majority pediatric malignancies.

Lymph hubs in the chest and midsection can be effectively tested through a negligibly obtrusive way to deal with stage thoracic and stomach growths like neuroblastoma, microbe cell cancers, and so forth. At times, intra-stomach lymph hubs might should be assessed for extra-stomach primaries too. For instance, iliac lymph hubs should be assessed in patients with testicular growths when an irregularity is recognized on figured tomography (CT) filter. This is significant for organizing in rhabdomyosarcoma and can, moreover, be remedial for patients with a microorganism cell growth of the testis.

During organizing, the liver surface can be reviewed for little, metastatic stores and biopsy performed under direct vision, with the affirmation that hemostasis has been accomplished. The peritoneal and pleural surfaces, locales of growth spread not generally precisely surveyed by imaging studies, can be totally assessed for sickness. At long last, knobs of the pneumonic parenchyma, identified by CT as a feature of an arranging assessment, can be biopsied to affirm or bar the presence of metastatic infection. This assurance can fundamentally affect the therapy plan and extreme visualization for youngsters with disease. Radiographic imaging has shown a mistake in organizing when contrasted with careful arranging of around 30% for youngsters with Hodgkin's illness.

In any case, since treatment of these patients has been so effective, with a high fix rate and low dreariness, careful organizing is at this point not a business as usual organizing of these youngsters. Nonetheless, there is still interest in a MIS way to deal with the assessment of nodal locales with dubious CT in situations where sickness stage and, subsequently, therapy will be essentially affected. This is especially obvious while recognizing stage II from stage III Hodgkin's infection where the utilization of alkylating specialists and radiation treatment is being thought of. Whether standard, complete careful arranging will get back to incline toward as the negligible dreariness and demonstrative exactness of laparoscopy in assessing the liver, spleen and lymph hubs is perceived, is questionable.

An extremely helpful indication for a laparoscopy or thoracoscopy is the evaluation of a primary tumor's resectability. Large pelvic cancers, particularly ovarian tumours, tumours of the chest wall, and liver tumours have all been evaluated with MIS often. The minimally invasive method can be utilised to examine the presence of multifocal disease, invasion of essential tissues, and anatomic linkages. If a tumour is found to be unresectable, a biopsy, if not already done, can be done quickly and conveniently at the same time.

One must keep track of the solid tumor's response to neo-adjuvant chemotherapy while treating solid tumors with many modalities. Imaging methods typically only have a limited amount of information to offer. Therefore, a laparoscopy can be utilized to see the tumor and assist in creating a future management strategy, such as for neuroblastomas, germ cell tumors, etc. Additionally, laparoscopy might be helpful for removing the leftover mass in the same session. When necessary, a liver biopsy could be performed safely during a laparoscopic examination.

Even after a main open resection, second-look procedures can be carried out. Through a minimum access method, tumour recurrence, both locoregional and metastatic, can be identified. The most common places for this to be done are retroperitoneal and pulmonary metastases. Thoracoscopy can easily access pulmonary metastases since they are typically peripheral lesions. Resection of metastatic lesions may be both diagnostic and therapeutic in some histologic types, which is beneficial for long-term survival. The inability to palpate the lung to rule out the presence of tiny metastatic foci is a limitation of the thoracoscopic method. However, it is not yet clear if the patient's survival will be affected if these lesions are not found and promptly removed.

Pediatric disease patients habitually go through concentrated, multimodal treatment and various entanglements that require careful mediation can emerge over the span of their treatment. A large number of these can be managed utilizing an insignificantly intrusive methodology. Patients will frequently become anorexic because of their treatment and may profit from a laparoscopic gastrostomy tube situation. Youngsters who can't endure enteral feeds of any sort and require all out parenteral nourishment (TPN) infrequently foster cholelithiasis as a result. Laparoscopic cholecystectomy can be acted in these patients for suggestive stones or for intense cholecystitis. Patients with mind growths might foster indicative gastroesophageal reflux.

On the off chance that the reflux is headstrong to clinical administration, they might profit from a laparoscopic Nissen fundoplication. Laparoscopic oophoropexy is frequently performed for females who are to go through abdominopelvic light.The kids with malignancies are immunosuppressed both due to their danger as well as their treatment. MIS can be an extremely helpful strategy for assessing injuries seen on radiographic work-up. Symptomatic tissue can be gotten to recognize among growth, a harmless interaction and an irresistible cycle and tissue for culture got to distinguish specific inducing creatures. This present circumstance emerges most often with sores (or diffuse cycles) of the lung, where a thoracoscopic lung biopsy can be performed, yet may happen in the liver or retroperitoneum.

Prior to surgery, laparoscopic vascular ligation has definite advantages in terms of simplicity of surgery and a bloodless operating room. The only tumour where laparoscopic ligation of the median sacral artery has been done effectively by numerous authors is a sacrococcygeal teratoma. [45–47]

The following are absolute prohibitions against MIS in paediatric surgical oncology: respiratory compromise of any cause, an infectious focus, particularly in the anterior abdominal wall, particularly in the periumbilical region, and a disorder of the coagulation in association. A few relative contraindications are: When the tumour is really large, intensive prior surgery that left dense intra-abdominal/thoracic adhesions and ablative MIS may be necessary to prevent tumour leakage and its consequences.

The conversion rate for paediatric surgical MIS procedures is typically stated to range from 7 to 10%[48], however it makes sense that it would be greater in diagnostic and ablative tumour treatments (29%).[18] In any event, judicious conversion to open surgery is not to be regarded as a problem. However, the literature has noted a number of MIS problems.

It is the most dreaded MIS treatment complication that could hinder postoperative recovery. [15]

Trocar site herniation is another known complication of MIS in children[49] and is seen to occur more often in children less than 5 years of age.[50]

The difficulty well defined for disease medical procedure in MIS is that of PSR. PSR is characterized as nearby, encircled cancer development at the site of at least one trocar locales or at the entry point site after laparoscopic or thoracoscopic medical procedure for disease. PSR is limited inside the stomach or thoracic walls, inside the scar tissue and includes at first the dermis and the subcutaneous fat and typically not the solid layer. On the off chance that these injuries happen inside a couple of months (roughly as long as 200 days) after endoscopic medical procedure, they fit into the rules of PSR.

PSR isn't indistinguishable with peritoneal metastases, serosal intrusion, skin metastases. A complete writing search uncovered just a single instance of PSR detailed in pediatric age bunch after thoracoscopic resection of pneumonic metastases inferable from osteogenic sarcoma.[51] going against the norm, a review directed by the Japanese Society of Pediatric Endosurgeons uncovered no PSR among 29 establishments which performed MIS techniques in youngsters with growths, and in this way presumed that it is an uncommon peculiarity in children.[3]

The most terrifying issue to arise with tumour removal is this. Malignant cells can be detected in the washing of the bag that had previously contained morcellated tissue, according to a study on cytologic washings recovered from the bag used for specimen collection and morcellation. This finding suggests that whenever there is tumour spillage during morcellation, malignant cells do lodge into surrounding tissue and change the stage of the tumour. [52] The morcellated tissue requires more difficult, laborious, and time-consuming pathologic investigation. Currently, the majority would advise making a separate incision so that the tumour can be completely removed without spilling.

The job of MIS in all youngsters with cancers is as yet begging to be proven wrong. MIS isn't just use of new innovation, yet rather a way of thinking that intends to limit the physiologic results of an activity, which incorporate torment, scarring, stress reaction and handicap. In contrast with open a medical procedure, MIS enjoys a few benefits: less torment, quicker recuperation time and improved cosmesis (a lot more modest cuts). Notwithstanding, any careful procedure to be laid out as better compared to the standard requires a drawn out committed learn about its materialness as well as entanglements and security of purpose.

Obviously, painstakingly controlled randomized examinations are expected to assist with deciding the advantages and disadvantages of this new, developing approach.In the new times, with further developed instrumentation and abilities in pediatric MIS, the treatment and organizing of cancers in kids laparoscopically is turning out to be increasingly famous. There are as yet a few restrictions to the utilization of laparoscopy in pediatric oncology and it is far fetched that MIS will supplant open a medical procedure yet future specialized improvements and its applications are hard to foresee.

1. Hatzinger M, Kwon ST, Langbein S, Kamp S, Häcker A, Alken P. Hans Christian Jacobaeus: Inventor of human laparoscopy and thoracoscopy. J Endourol. 2006;20:848–50. [PubMed] [Google Scholar]

2. Hsu TC. Intra-abdominal lesions could be missed by inadequate laparoscopy. Am Surg. 2008;74:824–6. [PubMed] [Google Scholar]

3. Sartorelli KH, Partrick D, Meagher DP., Jr Port-site recurrence after thoracoscopic resection of pulmonary metastasis owing to Osteogenic sarcoma. J Pediatr Surg. 1996;31:1443–4. [PubMed] [Google Scholar]

4. Duarte RJ, Dénes FT, Cristofani LM, Srougi M. Laparoscopic nephrectomy for Wilms’ tumor. 2009;9:753–61. [PubMed] [Google Scholar]

5. Landman Ja, Lento Pa, Hassen Wa, Ungera P, Waterhouse R. Feasibility of pathological evaluation of morcellated kidneys after radical nephrectomy. J Urol. 2000;164:2086–9. [PubMed] [Google Scholar]

6. Lobe TE, Schropp KP, Joyner R, Losater O, Jenkins J. The suitability of automatic tissue morcellation for the endoscopic removal of large specimens in pediatric surgery. J Pediatr Surg. 1994;29:232–4. [PubMed] [Google Scholar]

7. Chan KW, Lee KH, Tam YH, Yeung CK. Minimal Invasive Surgery in Pediatric Solid Tumors. J Laparoendosc Adv Surg Tech A. 2007;17:817–20. [PubMed] [Google Scholar]

8. Kaouk JH, Gill IS. Laparoscopic Radical Nephrectomy: Morcellate or Leave Intact? Leave Intact. Rev Urol. 2002;4:38–42. [PMC free article] [PubMed] [Google Scholar]

9. Tagge EP. Minimal access cancer management in children. In: Greene FL, Heniford BT, editors. Springer. USA: Minimally Invasive Cancer Management; 2001. pp. 335–46. [Google Scholar]

10. Ehrlich PF, Newman KD, Haase GM, Lobe TE, Wiener ES, Holcomb GW. Lessons learned from a failed multi-institutional randomized controlled study. J Pediatr Surg. 2002;37:431–6. [PubMed] [Google Scholar]

11. Klimkovich IG, Gel’dt VG, Okulov AB, Ovchinnikov AA, Poliakova ON. Thorascopy in children. Khirurgiia (Mosk) 1971;47:19–24. [PubMed] [Google Scholar]

12. Ryckman FC, Rodgers BM. Thoracoscopy for intrathoracic neoplasia in children. J Pediatr Surg. 1982;17:521–4. [PubMed] [Google Scholar]

13. Karamehmedovic O, Dangel P, Hirsig J, Rickham PP. Laparoscopy in childhood. J Pediatr Surg. 1977;12:75–81. [PubMed] [Google Scholar]

14. Rogers DA, Lobe TE, Schropp KP. Evolving uses of laparoscopy in children. Surg Clin North Am. 1992;72:1299–313. [PubMed] [Google Scholar]

15. Holcomb GW, 3rd, Tomita SS, Haase GM, Dillon PW, Newman KD, Applebaum H, et al. Minimally invasive surgery in children with cancer. Cancer. 1995;76:121–8. [PubMed] [Google Scholar]

16. Holcomb GW. Indications for Minimally Invasive Surgery in Pediatric Oncology. Pediatr Endosurg Innovative Tech. 2001;5:299–303. [Google Scholar]

17. Sailhamer E, Jackson CC, Vogel AM, Kang S, Wu Y, Chwals WJ, et al. Minimally invasive surgery for pediatric solid neoplasms. Am Surg. 2003;69:566–8. [PubMed] [Google Scholar]

18. Spurbeck WW, Davidoff AM, Lobe TE, Rao BN, Schropp KP, Shochat SJ. Minimally invasive surgery in pediatric cancer patients. Ann Surg Oncol. 2004;11:340–3. [PubMed] [Google Scholar]

19. Metzelder ML, Kuebler JF, Shimotakahara A, Glueer S, Grigull L, Ure BM. Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies. Cancer. 2007;109:2343–8. [PubMed] [Google Scholar]

20. Leclair MD, Sarnacki S, Varlet F, Heloury Y. Minimally-invasive surgery in cancer children. Bull Cancer. 2007;94:1087–90. [PubMed] [Google Scholar]

21. Chan KW, Lee KH, Tam YH, Yeung CK. Minimal Invasive Surgery in Pediatric Solid Tumors. J Laparoendosc Adv Surg Tech A. 2007;17:817–20. [PubMed] [Google Scholar]

22. Meehan JJ, Sandler A. Pediatric robotic surgery: A single-institutional review of the first 100 consecutive cases. Surg Endosc. 2008;22:177–82. [PubMed] [Google Scholar]

23. Leclair MD, de Lagausie P, Becmeur F, Varlet F, Thomas C, Valla JS, et al. Laparoscopic resection of abdominal neuroblastoma. Ann Surg Oncol. 2008;15:117–24. [PubMed] [Google Scholar]

24. DeBerrebi D, Michon J, Philippe-Chomette P, El Ghoneimi A, Garel C, Brisse H, et al. Laparoscopic adrenal surgery for neuroblastomas in children. J Urol. 2003;170:932–5. [PubMed] [Google Scholar]

25. Iwanaka T, Kawashima H, Uchida H. The laparoscopic approach of neuroblastoma. Semin Pediatr Surg. 2007;16:259–65. [PubMed] [Google Scholar]

26. Al-Shanafey S, Habib Z. Feasibility and safety of laparoscopic adrenalectomy in children: Special emphasis on neoplastic lesions. J Laparoendosc Adv Surg Tech A. 2008;18:306–9. [PubMed] [Google Scholar]

27. Saad DF, Gow KW, Milas Z, Wulkan ML. Laparoscopic adrenalectomy for neuroblastoma in children: A report of 6 cases. J Pediatr Surg. 2005;40:1948–50. [PubMed] [Google Scholar]

28. Iwanaka T, Arai M, Ito M, Kawashima H, Matoba K, Imaizumi S. Challenges of laparoscopic resection of abdominal neuroblastoma with lymphadenectomy. A preliminary report. Surg Endosc. 2001;15:489–92. [PubMed] [Google Scholar]

29. Rescorla FJ. Malignant adrenal tumors. Semin Pediatr Surg. 2006;15:48–56. [PubMed] [Google Scholar]

30. Misseri R. Adrenal surgery in the pediatric population. Curr Urol Rep. 2007;8:89–94. [PubMed] [Google Scholar]

31. Varlet F, Stephan JL, Guye E, Allary R, Berger C, Lopez M. Laparoscopic radical nephrectomy for unilateral renal cancer in children. Surg Laparosc Endosc Percutan Tech. 2009;19:148–52. [PubMed] [Google Scholar]

32. Rescorla FJ. Malignant adrenal tumors. Semin Pediatr Surg. 2006;15:48–56. [PubMed] [Google Scholar]

33. Misseri R. Adrenal surgery in the pediatric population. Curr Urol Rep. 2007;8:89–94. [PubMed] [Google Scholar]

34. Bissada MA, Safwat AS, Seyam RM, Al Sobhi S, Hanash KA, Bissada NK. Familial pheochromocytoma. Urol Oncol. 2008;26:361–3. [PubMed] [Google Scholar]

35. Kravarusic D, Pinto-Rojas A, Al-Assiri A, Sigalet D. Laparoscopic resection of extra-adrenal pheochromocytoma--case report and review of the literature in pediatric patients. J Pediatr Surg. 2007;42:1780–4. [PubMed] [Google Scholar]

36. Bax NM, van der Zee DC. The laparoscopic approach to sacrococcygeal teratomas. Surg Endosc. 2004;18:128–30. [PubMed] [Google Scholar]

37. Köhler C, Kühne-Heid R, Klemm P, Tozzi R, Schneider A. Resection of presacral ganglioneurofibroma by laparoscopy. Surg Endosc. 2003;17:1499. [PubMed] [Google Scholar]

38. Davidoff AM, Hebra A, Kerr J, Stafford PW. Laparoscopic oophorectomy in children. J Laparoendosc Surg. 1996;1:S115–9. [PubMed] [Google Scholar]

39. Jawad AJ, Al-Meshari A. Laparoscopy for ovarian pathology in infancy and childhood. Pediatr Surg Int. 1998;14:62–5. [PubMed] [Google Scholar]

40. Barbancho DC, Novillo IC, Vázquez AG, Díaz ML, Sánchez RT, Gordo MB. Laparoscopy for ovarian tumors in children. Cir Pediatr. 2007;20:15–8. [PubMed] [Google Scholar]

41. Yeung CK, Chowdhary SK, Chan KW, Lee KH, Till H. Atypical laparoscopic resection of a liver tumor in a 4-year-old girl. J Laparoendosc Adv Surg Tech A. 2006;16:325–7. [PubMed] [Google Scholar]

42. Yoon YS, Han HS, Choi YS, Lee SI, Jang JY, Suh KS, et al. Total laparoscopic left lateral sectionectomy performed in a child with benign liver mass. J Pediatr Surg. 2006;41:e25–8. [PubMed] [Google Scholar]

43. Dutta S, Nehra D, Woo R, Cohen I. Laparoscopic resection of a benign liver tumor in a child. J Pediatr Surg. 2007;42:1141–5. [PubMed] [Google Scholar]

44. Ofluoğlu O, Erol B, Mik G, Coskun C, Yildiz M. Image-guided minimal invasive surgical resection of osteoid osteomas of the long bones. Acta Orthop Traumatol Turc. 2006;40:207–13. [PubMed] [Google Scholar]

45. Lukish JR, Powell DM. Laparoscopic ligation of the median sacral artery before resection of a sacrococcygeal teratoma. J Pediatr Surg. 2004;39:1288–90. [PubMed] [Google Scholar]

46. Bax NM, van der Zee DC. Laparoscopic ligation of the median sacral artery before excision of type I sacrococcygeal teratomas. J Pediatr Surg. 2005;40:885. [PubMed] [Google Scholar]

47. Bax NM, van der Zee DC. Laparoscopic clipping of the median sacral artery in huge sacrococcygeal teratomas. Surg Endosc. 1998;12:882–3. [PubMed] [Google Scholar]

48. Meng M, Miller T, Cha I, Stoller MA. Cytology of morcellated Renal Specimens: Significance in Diagnosis and Dissemination. J Urol. 2003;169:45–8. [PubMed] [Google Scholar]

49. Te Velde EA, Bax NM, Tytgat SH, De Jong JR, Travassos DV, Kramer WL, et al. Minimally invasive pediatric surgery: Increasing implementation in daily practice and resident’s training. Surg Endosc. 2008;22:163–6. [PMC free article] [PubMed] [Google Scholar]

50. Waldhaussen JH. Incisional hernia in a 5-mm trocar site following pediatric laparoscopy. J Laparoendosc Surg. 1996;6:S89–90. [PubMed] [Google Scholar]

51. Paya K, Wurm J, Fakhari M, Felder-Puig R, Puig S. Trocar-site hernia as a typical postoperative complication of minimally invasive surgery among preschool children. Surg Endosc. 2008;22:2724–7. [PubMed] [Google Scholar]

52. Iwanaka T, Arai M, Yamamoto H, Fukuzawa M, Kubota A, Kouchi K, et al. No incidence of port-site recurrence after endosurgical procedure for pediatric malignancies. Pediatr Surg Int. 2003;19:200–3. [PubMed] [Google Scholar]

Yogesh Kumar Sarin . Minimally invasive procedures' uses and restrictions in paediatric surgical oncology. World Journal Of Hematology And Oncology 2022.