# The role of minimally invasive surgery for diagnosis and staging in paediatric surgical oncology

## TL;DR

Minimally invasive surgery helps diagnose and stage pediatric cancers with less risk and recovery time than traditional surgery.

## Contribution

The paper highlights the growing role of MIS in pediatric oncology, emphasizing its advantages and innovative imaging techniques.

## Key findings

- MIS outperforms open surgery in sample adequacy and complication rates for tumors like neuroblastoma and rhabdomyosarcoma.
- Video-assisted thoracoscopic surgery is effective for thoracic malignancies with minimal complications.
- Indocyanine green fluorescence imaging improves precision and safety in MIS procedures.

## Abstract

Minimally invasive surgery (MIS) has become increasingly important in paediatric surgical oncology for the diagnosis and staging of solid tumours, due to its advantages in reducing morbidity, pain and hospitalisation times compared to traditional open surgery. While ultrasound-guided core needle biopsy (USCNB) typically remains the primary method for tissue sampling, MIS becomes essential in cases where USCNB is impractical or ineffective, such as with inaccessible tumour locations or where detailed staging information is required. Recent studies highlight the effectiveness of MIS in obtaining high-quality biopsy samples in neuroblastoma, thoracic tumours, hepatoblastoma and rhabdomyosarcoma, frequently outperforming open surgical methods regarding sample adequacy and complication rates. Video-assisted thoracoscopic surgery has demonstrated particular efficacy with minimal complications across various thoracic malignancies. Additionally, laparoscopic and robotic approaches for retroperitoneal lymph node dissection in rhabdomyosarcoma have proven beneficial by significantly reducing postoperative complications and hospital stays compared to open methods. Innovative adjunct technologies such as indocyanine green (ICG) fluorescence imaging have further advanced MIS by providing superior visualisation of tumour margins, metastases and lymphatic structures, enhancing the precision and safety of procedures. Overall, the integration of MIS techniques, supported by advanced imaging methods like ICG, represents a significant advancement in paediatric oncology, offering reliable diagnostic and staging options with reduced patient morbidity. These approaches provide critical clinical advantages, positioning MIS as an essential component of contemporary paediatric surgical oncology practice.