SYNOPSIS

The use of laparoscopy by gynecologists in treating pediatric and adolescent patients is a relatively new phenomenon. We present the specialized instrumentation prerequisite to operating on patients in the pediatric-adolescent age-group. Preoperative considerations and generalized techniques unique to this population are discussed. Though laparoscopy has a myriad of indications, the main focus will be on treatment and diagnosis of pelvic pain, adnexal masses, and pelvic inflammatory disease. A discussion of incidental appendectomy in these patients will also be presented.

INTRODUCTION

Endoscopic surgery dates back to the Babylonian Talmud (Niddah Treatise, Section 65b). A lead funnel with a bent mouthpiece was introduced into the vagina, enabling direct visualization of the cervix. The first true laparoscopic procedure is credited to Ott in 1901, when he inserted a speculum through a small incision and, using a head mirror to focus light through the incision, inspected the abdominal viscera. Since that time, advances in the field have allowed surgeons to perform ever more complicated and intricate procedures. Of all the fields of surgery to benefit from laparoscopy, pediatric surgery is considered the newcomer. It was not until the production of high-quality, miniaturized instrumentation that surgeons began to look for applications of laparoscopy in the pediatric patient population. Few procedures were performed laparoscopically in this age-group before 1970 mainly because attempts at making smaller scopes resulted in unacceptable poor visualization.