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



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.


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.


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.


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.


Intraoperative complications Laparoscopy Neonate Surgery Thoracoscopy 



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.


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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

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