A toddler had a kidney removed through keyhole surgery last month at Mater Dei Hospital in a first for Malta that highlights the advancement of medical procedures.

Consultant paediatric surgeon John Cauchi made four five-millimetre incisions, rather than the usual larger cut, to remove a two-year-old boy's diseased kidney which would have given him trouble later in life.

Laparoscopic surgery, commonly referred to as keyhole surgery, allows a surgeon to operate through small cuts.

This was a third first at the local public hospital last month: Surgeons also treated a one-year-old suffering from epiphora, a condition that left her with watery eyes caused by a blockage in her tear duct. And two operations were transmitted live to the University of Malta Medical School's auditorium, where an international conference was being held.

Speaking to The Times, Mr Cauchi said that, apart from the obviously smaller scar, minimal access surgery allows patients to lead a better quality of life following the operation.

In fact, the toddler was ready to leave hospital 24 hours after surgery. A similar operation carried out in the traditional manner would have kept the patient in hospital for a few days.

The pain felt at the site of the surgery is also greatly reduced, meaning patients can return to normal life quicker. Moreover, there is a "definite decrease" in wound infections following surgery.

"There is a major improvement in quality of life," said Mr Cauchi.

Shorter hospital stays also mean that hospital costs are reduced despite the fact that laparoscopic equipment is expensive.

Mr Cauchi said that, although interest in keyhole surgery took the world by storm in the 1980s and 1990s, it did not immediately start being applied in paediatric surgery. One of the reasons was that the cuts on children are small anyway and there was also a dearth of laparoscopic instruments small enough to be used on children.

The first laparoscopic operation was carried out in Britain in May 1987 following eight years of research by Maltese doctor Sir Alfred Cuschieri and his team. Sir Alfred is considered a pioneer of keyhole surgery, surmounting resistance from the surgical world to develop the technique. Today about 60 per cent of operations in the UK are performed through a minimal access approach.