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Abstract The first study analyzing the use of thoracoscopy in young patients was published by Rodgers and Talbert in 1976. The introduction of laparoscopic cholecystectomy in 1988 led to an explosive increase in the utilization of minimally invasive surgical techniques of many different types, driving the development of more sophisticated instrumentation. In the last 10 or 15 years, the technique of thoracoscopy has enjoyed a true ”rebirth” and is currently accepted and utilized by virtually all practicing pediatric surgeons for a variety of indications. Anesthesia for pediatric thoracoscopy is very challenging as the pediatric anesthesiologist has to be well prepared in the various techniques of providing one lung anesthesia and manage the intra and postoperative complications. As might be imagined, the morbidity of thoracoscopy is less than that of a thoracotomy, particularly when wound complications and postoperative pain are considered. The most commonly requested thoracic procedure in pediatrics is a lung biopsy. The advances in equipments, including smaller scopes and instruments together with the development of new energy sources that can seal and divide not only blood vessels but also lung tissue as the Ligasure, have allowed the performance of nearly every operation that pediatric surgeons can do using thoracoscopic techniques. In fact, these procedures have proven to be so effective and associated with low morbidity that it has altered the algorithms for treatment of many of the most commonly seen diseases. Thoracoscopy may be associated with some complications as bleeding and prolonged air leak that is why the reviews of minimal access surgery in children illustrate the importance of proper education and training. Once the initial experience is developed, there is minimal morbidity associated with thoracoscopy. The continued improvement in technology combined with its careful application should lead to improved results and decreased costs and will expand the use of thoracoscopy to more pediatric surgical procedures |