Laparoscopic cholecystectomy is common procedure for symptomatic gall stones in adults. As gall stones are uncommon in children, laparoscopic cholecystectomy is not commonly performed in children. However, steps of laparoscopic cholecystectomy are same for adults and children and identification of structures in callot’s triangle is essential step. Sometimes, variations in anatomy are seen and in this child, segment 4 artery had long extra hepatic course and was traversing callot’s triangle. 10 year old boy admitted for elective laparoscopic cholecystectomy for symptomatic gall stones. Standard four port procedure was done. During dissection of callot’s triangle, after identification of cystic artery and cystic duct, one vessel was seen going towards gall bladder bed. As space is a constraint in children, the cystic artery and duct were clipped and vessel was dissected. This video describes the dissection of vessel. The variable anatomy of hepatic artery and bile duct is known to every surgeon and steps for identification are always taken during surgery. Segment 4 vessel, also known as middle hepatic artery, has a variable origin and course. It majority, it originates from left hepatic artery .However, it can also originate from right hepatic artery or rarely can be a branch of proper hepatic artery. If originating from right hepatic artery, most of segment four artery have extra hepatic course. The segment 4 artery traversing callot’s triangle is reported in literature, but is quite rare. It has clinical significance, as sometimes, if arterial branch is going towards gall bladder, we ligate it, thinking that it will enter gall bladder. However, as shown in this child, it was entering gall bladder fossa and entered liver. Clipping of this artery may not be of significance in many patients, but as it supplies ducts also, ischemia of segment 4 duct can happen. The child had an uneventful recovery. #pediatricsurgeon #medantahospital #childsurgery #laparoscopicsurgeon #laparoscopiccholecystectomy #gallbladderremoval #pediatrics

This video describes Laparoscopic excision of right adrenal ganglioneuroma in a 3 year old child.

For hugely dilated colon because of delayed presentation of Hirschsprung disease treatment options are: Colostomy followed by definitive repair after six months Single stage laparoscopic assisted pull through with frozen section Because of average nutritional status and no history of enterocolitis at present, after parent consent, single stage laparoscopic assisted pull through with frozen section planned Risk because of bowel disparity during coloanal anastomosis considered, but thought to be manageable. Because of narrow space for delivery of mesentery during pull through without laparoscopic mobilisation, laparoscopic mesenteric mobilisation was thought to be essential. Because of small space, silk suture was used to hang rectum in place of extra port. The child had an uneventful recovery

This video describes incidentally diagnosed carcinoid in a 7 year old child after Laparoscopic Appendicectomy.It was 1.2x.4x.4 in size, at tip. However, subserosal involvement was suspected in one of the histological slides.

Duplex with obstructed non functioning upper moiety and refluxing lower moiety – Approach can be Upper tract approach Lower tract approach Combined upper and lower tract approach Staged upper and lower tract approach We report a case in which we preferred staged approach

Idiopathic retroperitoneal non pancreatic pseudocyst is a rare entity with only few cases described in literature in adults and are extremely rare in children. We describe it in an 11 years old female child with video showing our approach of Laparoscopic assisted excision of this cyst.

Teratoma are not uncommon tumour I children. However, its location in upper abdomen is uncommon. In upper abdomen also, it can be attached to stomach(gastric teratoma), can be in hepatoduodenal ligament or can be in hepato-gastric ligament( Rarest, only 4 cases reported in literature, that too in adults). We wish to present a 4-year-old girl with teratoma of gastro hepatic ligament. It was adhered to upper border of pancreas and had feeding vessels from proximal part of splenic artery. It was also closely related to left gastric artery. We had successfully removed it by laparoscopic means and probably this is the first case ,which had been successfully removed laparoscopically.

This video describes surgical management of an adolescent girl with Crohn's disease. She was on medical treatment for last few years and presented to us with appendicular perforation with fever and local signs of inflammation. Early decision of surgical intervention was taken and right hemicolectomy was done. The cecum and ascending colon was involved with disease.

Short length of colon distal to colostomy can make definitive repair of anorectal malformations a difficult procedure with high chances of complications. We want to describe our experience of using Laparoscopic assisted anorectoplasty (LAARP) with distal colostomy mobilisation for management of these cases. we had successfully managed 5 children with this rare problem by distal colostomy mobilisation. The operative details are in video.

This video demonstrated importance of dissection in Cystohepatic  or hepatobiliary triangle during laparoscopic choledochal cyst surgery. This one year eight month girl had a right hepatic artery creating a large Moynihan hump from which two cystic artery were arising. The vessels were carefully dissected and hepaticoduodenostomy was completed successfully.

This video describes management of gastric outlet obstruction in a young child with Laparoscopic Heineke-Mikulicz pyloroplasty. He had few dilatations ,but had to undergo surgery.

Laparoscopic Assisted Transanal Pull Through (TAPT) for Hirschsprung disease In Neonate by Dr Shandip Sinha, Pediatric Surgeon

Appendicitis is an important cause of acute abdomen in children. Because of many factors, perforation can be a mode of presentation. This is being managed by Laparoscopy successfully be most of the Pediatric Surgeons. This video describes one of these children.

laparoscopic assisted surgery for anorectal malformation in a three months male child

This video describes Laparoscopic Herniotomy for encysted hydrocele of cord in a small child

clip showing hepaticodudenostomy for pediatric coledochal cyst

This video shows laparoscopic management of small intestine intussusception in a three year old child by Dr Shandip Sinha, Pediatric Surgeon. The child was initially managed conservatively,but developed red currant jelly stool.

Laparoscopy not commonly used for total colonic aganglionosis variant of Hirschsprung Disease.This video demonstrates feasibility of Laparoscopy for such cases.One and half year old male child with History of transverse colostomy at six months of age( no records available). However he was passing stool from colostomy with weight gain.No biopsy were available.IN first step, Laparoscopic biopsy done in which no appendix was found and Multiple samples from colon and terminal ileum were taken.Biopsy suggested absence of ganglion cells in colon and presence of ganglion cells in ileum. Thus Diagnosis of Total colonic aganglionosis was confirmed and Laparoscopic assisted total colectomy with Duhamel (ileorectal anastomosis ) planned . This video demonstrates the step.

Three years old male child with severe anaemia(Hb-3), diagnosed to have paraesophageal hiatus hernia with fundus of stomach as content, creating hourglass stomach. Laparoscopic reduction of hernia, resection of sac, repair of hiatal defect and Thal Fundoplication done. The child had an uneventful recovery.

Malrotation diagnosed during Laparoscopic pyeloplasty-what to do?

laparoscopic partial pericystectomy for hepatic hydatid cyst in a 9 year old child

laparoscopic assisted Transanal pull through(TAPT) for Hirschsprung Disease in a 4 month 4.5Kg child

a neonatal ovarian cyst being excised laparoscopically

small child with colonic duplication

acute appendicitis in a child.