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Minimal Access Surgery Department

The field of surgery undergoes constant evolution. With the evolution of inhalation anesthetics at Massachusetts General Hospital in 1846, the field of surgery truly expanded. Before then, surgical procedures were avoided and, if performed, were brief. The best surgeon was the fastest surgeon who thereby caused less pain to his restrained and unanesthetized patient

Minimal access surgery (MAS) has been in existence since the early 19th century. In 1795, Dr Bozzini developed the Lichtleiter, a crude endoscope, which used a candle as illumination, for exploring intracavitary organs through external orifices. In 1868, Kussmaul performed esophagogastroscopy on a willing sword-swallower using his first open tube in the gullet, illuminated by the reflected light of gasoline lamp. In 1901, Kelling performed the first examination of the abdomen using a cystoscope in a dog. A tremendous breakthrough occurred in 1966 when Hopkins invented the rod lens system. Around the same time, Semm developed an automatic insufflator that monitored intra-abdominal pressure and gas flow. Semm also performed the first incidental laparoscopic appendectomy in 1983.

Advantages of MAS were realized by the adult surgeons long before it was accepted in the pediatric community. Initially, performing MAS in the pediatric population was resisted for the following reasons:

»  A widely held belief was that children did not experience pain.
»  The cost of laparoscopy was believed to be too high
»  Equipment was not small enough
»  MAS was believed to be too difficult to perform and too difficult to learn.
»  The cases were thought to take too long to set up and to perform.