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Multicentric assessment of the safety of neonatal videosurgery

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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.

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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.

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Authors and Affiliations

  1. Service de Chirurgie Viscérale Pédiatrique, Hôpital Lapeyronie, 275 Av Doyen Gaston Giraud, 34295, Montpellier, France

    Nicolas Kalfa, Hossein Allal, Dominique Forgues, Manuel Lopez, Marie-Pierre Guibal & Rene-Benoit Galifer

  2. Département d’Anesthésie Réanimation A, Hôpital Lapeyronie, 275 Av Doyen Gaston Giraud, 34295, Montpellier, France

    Olivier Raux

  3. Service de Chirurgie Viscérale Pédiatrique, Hôpital Clocheville, CHU Tours, France

    Hubert Lardy

  4. Service de Chirurgie Infantile, Hôpital Nord, CHU St Etienne, France

    Francois Varlet

  5. Service de Chirurgie Viscérale Pédiatrique, Hôpital Vaudois, CHUV Lausanne, Switzerland

    Olivier Reinberg

  6. Service de Chirurgie Pédiatrique, Hôpital Mère-Enfant, CHU Nantes, France

    Guillaume Podevin & Yves Héloury

  7. Service de Chirurgie Infantile, Hôpital de Hautepierre, CHU Strasbourg, France

    Francois Becmeur & Isabelle Talon

  8. Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU Bordeaux, France

    Luke Harper & Pierre Vergnes

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  1. Nicolas Kalfa
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  2. Hossein Allal
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  9. Francois Becmeur
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  11. Luke Harper
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  13. Dominique Forgues
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  14. Manuel Lopez
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  16. Rene-Benoit Galifer
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Corresponding author

Correspondence to Hossein Allal.

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Kalfa, N., Allal, H., Raux, O. et al. Multicentric assessment of the safety of neonatal videosurgery. Surg Endosc 21, 303–308 (2007). https://doi.org/10.1007/s00464-006-0044-1

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  • DOI: https://doi.org/10.1007/s00464-006-0044-1

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