The minimally invasive surgery  and regenerative medicine: clinical and experimental aspects
Creators: name: Alicchio, Francesca
Publisher: name: Università degli Studi di Napoli Federico II
Year: 2013

description: The field of  pediatric surgery has undergone numerous changes throughout the past few years.
First of all the laparoscopic surgery, introduced with  reluctance because many of the instruments were not appropriate for their tiny patients. Finally, the often quoted benefits of smaller scars, less pain, and shorter hospital stays had not been shown to be true in the pediatric patient.  However, in the mid 1990s, surgeons began to publish their laparoscopic pediatric cases, showing  laparoscopy to be a potential alternative for these patients. When pediatric surgeons began to perform laparoscopic procedures on small children and neonates, they were often forced to use instruments designed for adult patients. In the mid 1990s, 2- and 3-mm instruments were developed, which allowed surgeons to work with greater ease in confined spaces. Around the same time, a neonatal insufflator  was also developed. In contrast to adult insufflators, neonatal insufflators deliver CO2 in small, controlled puffs. This technology reduced the risk of over-insufflation that was often associated with using the oversized adult insufflators in small children. Over-insufflation can often be accompanied by a significant increase in end-tidal carbon dioxide, or the measurement of the amount of carbon dioxide in the expired air. If this is not adjusted for by the anesthesiologist, overinsufflation can lead to significant pulmonary complications in already fragile neonates. With these advances, more pediatric surgeons are expanding their repertoire of minimally invasive operations.
Not only are they increasing the number of cases that can be performed laparoscopically, but they are also showing that they can be safely performed on neonates weighing 5 kg and less.
In  parallel the regenerative medicine was a relatively new field. 
This combining tissue engineering and cell transplantation, with the aim of replacing damaged tissues and organs using living cells.
The regenerative medicine could lead to new ways of repairing or replacing injured organs, even during fetal development and therefore even children could benefit from this exciting field. Moreover, particularly in the field of tissue engineering, there has been a remarkable contribution from academic pediatric surgeons such as Anthony Atala and Joseph Vacanti. 
Congenital malformations are major causes of disease and death during the first years of life and most of the time functional replacement of the missing or damaged organ (or tissue) remains an unmet clinical need. Tissue engineering led by advances in two specific fields, cell biology and materials science, has combined to create the perfect biological substitution, while materials science and polymer generation, both of natural and synthetic origin, have had constant evolution.
This thesis reports the results obtained during my PhD course in “Human, Reproduction, Development and Growth” (XXV Cycle) from 2009 to 2012.
During the past 3 years  I have been focused my research in these main fields following 3 lines of research:
-	Evaluation of  changes of  intestinal adaptation in animal model of short bowel syndrome and the possibility to increase the intestinal surface used a 3D scaffold as guide for the lengthening of the intestinal wall until complete absorption of the same scaffold 
-	Study of the possibility of increase of the bladder and urethral surface used an animal model and a 3D scaffold as guide until complete absorption of the same scaffold in bladder 
-	The standardization of laparoscopic techniques in pediatric patients by multicentric study.