Minimally invasive surgery aims to minimize the surgical trauma caused to the patient during diagnostic and/or therapeutic procedures. In pediatric surgery, techniques such as laparoscopy, thoracoscopy, and endoscopy of the digestive and urinary systems are applied, allowing for small or even no incisions.

The advantages of minimally invasive surgery are numerous:

• Reduced surgical trauma
• Better visualization of the entire abdominal cavity
• Minimal postoperative pain
• Reduced risk of postoperative adhesions
• Superior cosmetic results
• Faster return to normal activities for the child

Minimally invasive techniques are now used for a wide range of conditions, in all age groups—from newborns to adolescents.

Laparoscopic surgery involves performing abdominal operations by inserting a camera (usually 5 mm) through the umbilicus and using 3 or 5 mm instruments through the abdominal wall. The incisions are very small, and the entire abdomen can be visualized via the camera. For some procedures, such as cholecystectomy, laparoscopy is now considered the procedure of choice, unless there are contraindications.

Endoscopic techniques use a thin, flexible tube with a camera, introduced through the natural openings of the body (mouth, urethra, anus) to visualize the interior of organs and perform interventions (e.g., cystoscopy, endoscopic correction of vesicoureteral reflux, removal of foreign bodies from the upper digestive tract, esophageal dilatations). In some cases, endoscopic techniques are combined with traditional or percutaneous approaches, such as in percutaneous endoscopic gastrostomy (PEG), where the only incision in the abdomen is just a few millimeters for the feeding tube.

In certain cases, classic open surgery has been replaced by percutaneous techniques, where small catheters are introduced through the skin using a needle, allowing for minimally invasive procedures (e.g., percutaneous placement of central venous catheters, percutaneous drainage of intra-abdominal abscesses).

Key requirements for the safe application of these techniques include proper training of the pediatric surgeon, the use of modern technological equipment, and careful selection of the appropriate surgical approach tailored to each patient’s needs.