Developing neonatal minimally invasive surgery: Innovation, techniques, and helping an industry to change

Minimal Access Surgery in Neonates

“…Two years later, Rothenberg reported the first thoracoscopic lung lobectomy [2].in 1994-95, Willital created the premier pediatric MIS society IPEG (International Pediatric Endosurgery Group) [11]. Lobe & Rothenberg performed first thoracoscopic pure esophageal atresia repair in Berlin in 1999 [12]. Next year, Georgeson [13] described first laparoscopic assisted anorectal pull-through.…”

“…Ponsky reported single port laparoscopy in children in 2009 [2]. When very fine devices, precise movements and intelligent workarounds allowed surgeons to apply in MIS for neonates, the noble subfield of "Neonatal MIS" developed [2,7,12].…”

“…The instruments are too long, too wide and just too big making no ergonomic sense [2,12]. For example, no 3mm, 20cm shear are available leaving surgeons the choice of using a blunt instrument longer than the patient or altering technique to incorporate different technology [2,12].…”

“…Surface available for insertion of these instruments and the internal working place is limited so the tip of the instruments can move away of vision causing inadvertent injuries. Tremors and imprecise movements are exaggerated because of smaller extracorporeal and larger intra-corporeal length of instruments and magnification [4,12]. The abdominal surface to cavity ratio in neonates is less than that in adults and abdominal wall of them is very lax, as well as close proximity of structures putting trocar placement at risk [4,7,15,19].…”

“…Infants may be placed at the foot end of the table and secured properly. Well padding of the extremities should be ensured [12]. In neonates, periumbilical area should not be used for post placement because of the risks of puncturing the umbilical vessels [19].…”