Peritoneoscopy in infants and children

Peritoneoscopy is the visualization of the contents of the peritoneal cavity by means of a small telescope introduced through the anterior abdominal wall after establishment of a pneumoperitoneum. This procedure, also referred to as laparoscopy or celioscopy, is “rediscovered” with brief flurries of popularity every few years with the development of new instruments and new techniques. The greatest use and most lasting progress have been made by the gynecologists. The method has also had limited success in the hands of the internist and surgeon, particularly in evaluating liver disease. However, benefits to pediatrics have been few, if any, and it is rare to find mention of the procedure in the pediatric literature, or use of the method in the pediatric treatment centers of the world. No doubt this is due to the fact that when conventional telescopes are miniaturized for pediatric use, the view is so poor that it is relatively useless.In recent years technical advances have made possible significant improvements in telescopic endoscopy.¹ The most significant of these is the development by Hopkins of the rod lens optical system, which can be miniaturized for pediatric use, at the same time achieving a wide angle view and increased transmission of light. A high-intensity cold light is brought to the subject by fiber optic threads placed along the length of the glass rod lenses.Stimulated by these advances, it was decided to evaluate the method for infants and children, to explore its parameters, to recognize its limitations, and to establish a safe and satisfactory technique. Because of the lack of details in the literature and the absence of experience in other pediatric centers, a modification of the adult procedure was employed as a starting point for the development of the present method.