Advertisement

Surgical Endoscopy

, Volume 21, Issue 2, pp 303–308 | Cite as

Multicentric assessment of the safety of neonatal videosurgery

  • Nicolas Kalfa
  • Hossein AllalEmail author
  • Olivier Raux
  • Hubert Lardy
  • Francois Varlet
  • Olivier Reinberg
  • Guillaume Podevin
  • Yves Héloury
  • Francois Becmeur
  • Isabelle Talon
  • Luke Harper
  • Pierre Vergnes
  • Dominique Forgues
  • Manuel Lopez
  • Marie-Pierre Guibal
  • Rene-Benoit Galifer
Article

Abstract

Background

Complex procedures for managing congenital abnormalities are reported to be feasible. However, neonatal videosurgery involves very specific physiologic constraints. This study evaluated the safety and complication rate of videosurgery during the first month of life and sought to determine both the risk factors of perioperative complications and the most recent trends in practice.

Methods

From 1993 to 2005, 218 neonates (mean age, 16 days; weight, 3,386 g) from seven European university hospitals were enrolled in a retrospective study. The surgical indications for laparoscopy (n = 204) and thoracoscopy (n = 14) were congenital abnormalities or exploratory procedures.

Results

Of the 16 surgical incidents that occurred (7.5%), mainly before 2001, 11 were minor (parietal hematoma, eventration). Three neonates had repeat surgery for incomplete treatment of pyloric stenosis. In two cases, the incidents were more threatening (duodenal wound, diaphragmatic artery injury), but without further consequences. No mortality is reported. The 26 anesthetic incidents (12%) that occurred during insufflation included desaturation (<80% despite 100% oxygen ventilation) (n = 8), transient hypotension requiring vascular expansion (n = 7), hypercapnia (>45 mmHg) (n = 5), hypothermia (<34.9°C) (n = 4), and metabolic acidosis (n = 2). The insufflation had to be stopped in 7% of the cases (transiently in 9 cases, definitively in 6 cases). The significant risk factors for an incident (p < 0.05) were young age of the patient, low body temperature, thoracic insufflation, high pressure and flow of insufflation, and length of surgery.

Conclusion

Despite advances in miniaturizing of instruments and growth in surgeons’ experience, the morbidity of neonatal videosurgery is not negligible. A profile of the patient at risk for an insufflation-related incident emerged from this study and may help in the selection of neonates who will benefit most from these techniques in conditions of maximal safety.

Keywords

Intraoperative complications Laparoscopy Neonate Surgery Thoracoscopy 

Notes

Acknowledgment

We thank Dr. I. Valioulis at the Department of Pediatric Surgery, Aghios Loukas Hospital, Panorama Thessaloniki, Greece, and Professor Michel Robert at the Service de Chirurgie Viscérale Pédiatrique, Hôpital Clocheville, CHU Tours, France, for their participation in this study.

References

  1. 1.
    Bax NM, Ure BM, van der Zee DC, van Tuijl I (2001) Laparoscopic duodenoduodenostomy for duodenal atresia. Surg Endosc 15: 217CrossRefPubMedGoogle Scholar
  2. 2.
    Rothenberg SS (2002) Laparoscopic duodenoduodenostomy for duodenal obstruction in infants and children. J Pediatr Surg 37: 1088–1089CrossRefPubMedGoogle Scholar
  3. 3.
    Rothenberg SS (2002) Thoracoscopic repair of tracheoesophageal fistula in newborns. J Pediatr Surg 37: 869–872CrossRefPubMedGoogle Scholar
  4. 4.
    van der Zee DC, Bax NM (1995) Laparoscopic repair of acute volvulus in a neonate with malrotation. Surg Endosc 9: 1123–1124CrossRefPubMedGoogle Scholar
  5. 5.
    Bax KM, van Der Zee DC (2002) Feasibility of thoracoscopic repair of esophageal atresia with distal fistula. J Pediatr Surg 37: 192–196CrossRefPubMedGoogle Scholar
  6. 6.
    Gertner M, Farmer DL (2004) Laparoscopic cholecystecomy in a 16-day-old infant with chronic cholelithiasis. J Pediatr Surg 39: E17–E19CrossRefPubMedGoogle Scholar
  7. 7.
    Gluer S, Scharf A, Ure BM (2002) Thoracoscopic resection of extralobar sequestration in a neonate. J Pediatr Surg 37: 1629–1631CrossRefPubMedGoogle Scholar
  8. 8.
    Wurst H, Schulte-Steinberg H, Finsterer U (1993) Pulmonary CO2 elimination in laparoscopic cholecystectomy: a clinical study. Anaesthesist 42: 427–434PubMedGoogle Scholar
  9. 9.
    Bozkurt P, Kaya G, Yeker Y, Tunali Y, Altintas F (1999) The cardiorespiratory effects of laparoscopic procedures in infants. Anaesthesia 54: 831–834CrossRefPubMedGoogle Scholar
  10. 10.
    Coppola L, Avogaro F, Vendramin ML, Belloli GP (1985) Anesthesiologic management of surgery in the 1st month of life: review of the literature and clinical contribution. Pediatr Med Chir 7: 503–511PubMedGoogle Scholar
  11. 11.
    Romero T, Covell J, Friedman WF (1972) A comparison of pressure–volume relations of the fetal, newborn, and adult heart. Am J Physiol 222: 1285–1290PubMedGoogle Scholar
  12. 12.
    Fujimoto T, Segawa O, Lane GJ, Esaki S, Miyano T (1999) Laparoscopic surgery in newborn infants. Surg Endosc 13: 773–777CrossRefPubMedGoogle Scholar
  13. 13.
    Iwanaka T, Arai M, Ito M, Kawashima H, Imaizumi S (2000) Laparoscopic surgery in neonates and infants weighing less than 5 kg. Pediatr Int 42: 608–612CrossRefPubMedGoogle Scholar
  14. 14.
    Truchon R (2004) Anaesthetic considerations for laparoscopic surgery in neonates and infants: a practical review. Best Pract Res Clin Anaesthesiol 18: 343–355CrossRefPubMedGoogle Scholar
  15. 15.
    Kalfa N, Allal H, Raux O, Lopez M, Forgues D, Guibal MP, Picaud JC, Galifer RB (2005) Tolerance of laparoscopy and thoracoscopy in neonates. Pediatrics 116: e785–791CrossRefPubMedGoogle Scholar
  16. 16.
    Rangel SJ, Henry MC, Brindle M, Moss RL (2003) Small evidence for small incisions: pediatric laparoscopy and the need for more rigorous evaluation of novel surgical therapies. J Pediatr Surg 38: 1429–1433CrossRefPubMedGoogle Scholar
  17. 17.
    Esposito C, Ascione G, Garipoli V, De Bernardo G, Esposito G (1997) Complications of pediatric laparoscopic surgery. Surg Endosc 11: 655–657CrossRefPubMedGoogle Scholar
  18. 18.
    Esposito C, Lima M, Mattioli G, Mastroianni L, Centonze A, Monguzzi GL, Montinaro L, Riccipetitoni G, Garzi A, Savanelli A, Damiano R, Messina M, Settimi A, Amici G, Jasonni V, Palmer LS (2003) Complications of pediatric urological laparoscopy: mistakes and risks. J Urol 169: 1490–1492CrossRefPubMedGoogle Scholar
  19. 19.
    Peters CA (1996) Complications in pediatric urological laparoscopy: results of a survey. J Urol 155: 1070–1073CrossRefPubMedGoogle Scholar
  20. 20.
    Bannister CF, Brosius KK, Wulkan M (2003) The effect of insufflation pressure on pulmonary mechanics in infants during laparoscopic surgical procedures. Paediatr Anaesth 13: 785–789CrossRefPubMedGoogle Scholar
  21. 21.
    Gueugniaud PY, Abisseror M, Moussa M, Godard J, Foussat C, Petit P, Dodat H (1998) The hemodynamic effects of pneumoperitoneum during laparoscopic surgery in healthy infants: assessment by continuous esophageal aortic blood flow echo-Doppler. Anesth Analg 86: 290–293PubMedGoogle Scholar
  22. 22.
    Manner T, Aantaa R, Alanen M (1998) Lung compliance during laparoscopic surgery in paediatric patients. Paediatr Anaesth 8: 25–29CrossRefPubMedGoogle Scholar
  23. 23.
    McHoney M, Corizia L, Eaton S, Kiely EM, Drake DP, Tan HL, Spitz L, Pierro A (2003) Carbon dioxide elimination during laparoscopy in children is age dependent. J Pediatr Surg 38: 105–110CrossRefPubMedGoogle Scholar
  24. 24.
    Hazebroek EJ, Haitsma JJ, Lachmann B, Steyerberg EW, de Bruin RW, Bouvy ND, Bonjer HJ (2002) Impact of carbon dioxide and helium insufflation on cardiorespiratory function during prolonged pneumoperitoneum in an experimental rat model. Surg Endosc 16: 1073–1078CrossRefPubMedGoogle Scholar
  25. 25.
    Sefr R, Puszkailer K, Jagos F (2003) Randomized trial of different intraabdominal pressures and acid–base balance alterations during laparoscopic cholecystectomy. Surg Endosc 17: 947–950CrossRefPubMedGoogle Scholar
  26. 26.
    Wulkan ML, Vasudevan SA (2001) Is end-tidal CO2 an accurate measure of arterial CO2 during laparoscopic procedures in children and neonates with cyanotic congenital heart disease? J Pediatr Surg 36: 1234–1236CrossRefPubMedGoogle Scholar
  27. 27.
    Hazebroek EJ, Schreve MA, Visser P, De Bruin RW, Marquet RL, Bonjer HJ (2002) Impact of temperature and humidity of carbon dioxide pneumoperitoneum on body temperature and peritoneal morphology. J Laparoendosc Adv Surg Tech A 12: 355–364CrossRefPubMedGoogle Scholar
  28. 28.
    Moore SS, Green CR, Wang FL, Pandit SK, Hurd WW (1997) The role of irrigation in the development of hypothermia during laparoscopic surgery. Am J Obstet Gynecol 176: 598–602CrossRefPubMedGoogle Scholar
  29. 29.
    Ott DE (1991) Laparoscopic hypothermia. J Laparoendosc Surg 1: 127–131CrossRefPubMedGoogle Scholar
  30. 30.
    Gray RI, Ott DE, Henderson AC, Cochran SA, Roth EA (1999) Severe local hypothermia from laparoscopic gas evaporative jet cooling: a mechanism to explain clinical observations. JSLS 3: 171–177PubMedPubMedCentralGoogle Scholar
  31. 31.
    Georgeson KE, Robertson DJ (2004) Minimally invasive surgery in the neonate: review of current evidence. Semin Perinatol 28: 212–220CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Nicolas Kalfa
    • 1
  • Hossein Allal
    • 1
    Email author
  • Olivier Raux
    • 2
  • Hubert Lardy
    • 3
  • Francois Varlet
    • 4
  • Olivier Reinberg
    • 5
  • Guillaume Podevin
    • 6
  • Yves Héloury
    • 6
  • Francois Becmeur
    • 7
  • Isabelle Talon
    • 7
  • Luke Harper
    • 8
  • Pierre Vergnes
    • 8
  • Dominique Forgues
    • 1
  • Manuel Lopez
    • 1
  • Marie-Pierre Guibal
    • 1
  • Rene-Benoit Galifer
    • 1
  1. 1.Service de Chirurgie Viscérale PédiatriqueHôpital LapeyronieMontpellierFrance
  2. 2.Département d’Anesthésie Réanimation AHôpital LapeyronieMontpellierFrance
  3. 3.Service de Chirurgie Viscérale PédiatriqueHôpital ClochevilleCHU ToursFrance
  4. 4.Service de Chirurgie InfantileHôpital NordCHU St EtienneFrance
  5. 5.Service de Chirurgie Viscérale PédiatriqueHôpital VaudoisCHUV LausanneSwitzerland
  6. 6.Service de Chirurgie PédiatriqueHôpital Mère-EnfantCHU NantesFrance
  7. 7.Service de Chirurgie InfantileHôpital de HautepierreCHU StrasbourgFrance
  8. 8.Service de Chirurgie PédiatriqueHôpital Pellegrin-EnfantsCHU BordeauxFrance

Personalised recommendations