1. Minimally Invasive Surgery in Pediatric Surgery 三軍總醫院 小兒外科 朱志純 為恭紀念醫院 2007.9.4

2. Fewer and fewer kids ---Quantity and Quality 1 2 3 4 5 民國 50 年 60 70 80 90 每 一 婦 女 平 均 生 育 數 2.46 3.71 1.72 5.59 人 6 1 2 3 4 5 91 每 一 婦 女 平 均 生 育 數 1.40 2.46 3.71 1.72 5.59 人 6 1.34 人 1.24 人 92 年

3. 微創手術 Minimally invasive surgery

6. Minimally invasive surgery—hernia repair

7. Minimally invasive surgery— pyloromyotomy for hypertrophic infantile pyloric stenosis

8. 傳統切口及微創切口

10. All-in-1 Laparoscope with working channel, air-inflation, irrigation & suction

16. Single umbilical-punctured laparoscope-assisted appendectomy Low cost Low infection rate No visible scar Short LOS

18. Anti-reflux procedure--- Intravesicle approach

19. Anti-reflux procedure--- Extravesicle approach

20. Submucosal injection of Deflux

21. Submucosal injection of Deflux

22. Submucosal Deflux injection Gr. VI No reflux

24. Preserve the perichondrum and remove all the deformed cartilage

25. Ravitch Procedure (removal deformed cartilage, fracture of the sternum)

27. Ravitch 手術 1943~ Ossification of the cartilage Scarring Blood loss

28. Scars

30. After sternum turn-over (Wada)

31. Dr. Donald Nuss

32. Nuss Procedure

33. Dr. Park Hyung Joo

34. The pectus bar is supported by the ribs and the intercostal soft tissue.

36. (Park, et al., 2004) saucer- shaped Asymmetric II funnel-shaped Symmetric I eccentric unbalanced

37. Dr. Park

38. Pre-operative device remolding

41. Nuss procedure

44. Crane Technique

48. STERNUM SUPPORTING RIB

49. Stabilizer: avoids flipping of the bar

50. Kids are growing!

51. Funnel-shaped depression 手術前 手術後

52. Saucer-shaped depression

53. Asymmetric

54. Female

55. Re-do after Ravitch

58. Lung entrapment