Feasibility of complex minimally invasive surgery in neonates

Abstract

The aim of this study was to assess the feasibility of complex minimally invasive surgery in neonates (and infants <5 kg). A systematic search of databases was performed. Inguinal herniotomy and pyloromyotomy were specifically excluded. Various operations were assessed for operative times, conversion rates, complications and centres performing the procedures. From 479 abstracts, 50 papers were identified describing 1,215 patients. Common operations performed were fundoplication (n = 473), operations for ovarian pathology (n = 151) and oesophageal atresia repair (n = 123). Other not-so-common operations included Kasai procedure (n = 61), Ladd's procedure (n = 55), bowel atresia surgery (n = 45) and congenital diaphragmatic hernia repair (n = 41). Mean operation times varied from 43 min for fundoplication to 209 min for Kasai procedure, with other operation times falling in between the two extremes. Likewise, conversion rates varied from 0.2% for fundoplication to 15% for congenital diaphragmatic hernia, with other conversion rates falling in between. Complications ranged from 0 to 67%. About 70-94% of the cases were performed in six pioneering centres. Fundoplication and operations for ovarian pathology have low complication and conversion rates and appear to be well suited to the average-trained paediatric laparoscopic surgeon. More complex procedures are feasible and safe, but technically demanding and need further expertise.

Feasibility and Safety of Laparoscopic Ablative Renal Surgery in Infants: Comparative Study with Children

“…Moreover, age at surgery has become increasingly younger due to the miniaturization of instruments and evolution of video technology. 4,5 Despite these developments, laparoscopy as a method for treating urological problems has been slower to be adopted in children than in adults. As mentioned previously, the reasons include excellent success rates with open surgery and longer operative times with steeper learning curves for laparoscopy.…”

“…4,5 However, few studies have dealt with laparoscopic renal surgery in infants. Initial reports on urological laparoscopy revealed that children younger than 1 year had more morbidity due to the small working space.…”

Minimally invasive surgery in neonates

“…Sinha ve ark. 'nın (20) 2010 yılında internet aracılığı ile yaptıkları derlemede (50 adet makale), yenidoğan döneminde yapılan minimal invazif cerrahi girişimler içinde en sık yapılan ameliyatın fundoplikasyon olduğu ve hatta bazı merkezlerin günübirlik laparoskopik Nissen yaptıklarını bildirmiştir (21) .…”

“…Ayrıca torakoskopik girişimde karbondioksit emilimine bağlı olarak nörotoksik yan etkilerin olması, uzun süren hiperkapni ve asidoz olması açık cerrahiyi tercih ettirmektedir (9) . Yenidoğan minimal invazif uygulamalarda (5 kg altı infantlar dahil) en sık açık cerrahiye geçiş oranı %15'tir ve diyafram hernisi onarımında görülmektedir (40) .…”

The risks of minimal access surgery in children: an aid to consent

“…The benefits and potential complications of complex minimally invasive surgery (MIS) in pediatrics are well documented [2][3][4][5]. However, there is a lack of published data on the absolute risks of this type of surgery [6].…”