# General principles of minimally invasive surgery in paediatric surgical oncology

## TL;DR

Minimally invasive surgery in pediatric oncology offers benefits but requires strict adherence to oncological principles to avoid complications.

## Contribution

This paper reviews general principles and guidelines for safely applying minimally invasive surgery in pediatric surgical oncology.

## Key findings

- MIS in pediatric oncology can lead to faster recovery and better cosmetic outcomes.
- Strict adherence to oncological principles is essential to avoid complications like tumor spillage.
- MIS is suitable for specific tumors like neuroblastoma and Wilms tumor under certain conditions.

## Abstract

Minimally invasive surgery (MIS) has become increasingly integrated into Paediatric Surgical Oncology (PSO), offering benefits such as faster recovery, reduced postoperative pain, earlier resumption of adjuvant therapy, lower blood loss and improved cosmetic outcomes. Despite these advantages, the safe application of MIS in oncology requires strict adherence to oncological principles to avoid complications such as tumour spillage, incomplete resections and staging errors, which may compromise survival outcomes. This article reviews the general principles, indications and contraindications for MIS in paediatric oncology, highlighting tumour- and histology-specific considerations. Commonly accepted MIS applications include selected cases of neuroblastoma, Wilms tumour following neoadjuvant therapy under SIOP protocols, thoracoscopic lung metastasectomy and resection of certain mediastinal, hepatic and adnexal masses. Contraindications include large or fragile tumours, high-risk neuroblastomas with vascular encasement and situations where surgeon experience or resources are insufficient. Technical aspects, patient selection and multidisciplinary coordination are emphasised as key to ensuring safety and efficacy. Establishing MIS guidelines in PSO may aid surgeons in decision-making and promote consistent standards of care.