Intraoperative Endoscopy as an Adjuvant to Minimally Invasive Surgery in Pediatrics

Background: Minimally invasive surgery has a different visual and tactile perception compared with conventional surgery, which could lead to complications, especially in complex procedures. In these cases, flexible endoscopy can facilitate and prevent complications in minimally invasive procedures in children. The study aimed to clarify the utility of intraoperative endoscopy as an adjuvant to minimally invasive surgery in children. Materials and Methods: This retrospective study reviewed the medical records of pediatric patients who had undergone endoscopy during a minimally invasive surgery to treat an upper digestive pathology between January 2000 and December 2020. Results: The study included 83 patients who underwent a laparoscopic procedure with simultaneous endoscopy. The diagnosis was peptic stenosis in 9 patients, achalasia in 23, congenital embryonic tracheobronchial remnants in 4, re-fundoplication in 42, esophageal duplication in 2, superior mesenteric artery syndrome in 2, and giant gastric hemangioma in 1 patient. With adjuvant endoscopy, 7 digestive perforations were noted, 11 cases of short esophagus were diagnosed, and the permeability of the anastomosis was confirmed in 6 cases. No complications were related with the endoscopy procedures. Discussion: Minimally invasive surgery has a few special and tactile limitations that can lead to complications in certain procedures. Simultaneous digestive endoscopy in the upper gastrointestinal tract facilitates organ identification and dissection. Conclusion: Digestive endoscopy is an excellent adjunct to minimally invasive surgery in children because it facilitates and identifies complications and ensures safer minimally invasive surgeries. Future prospective studies are required to assess this conclusion.