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Expanding safety boundaries in pediatric robotic-assisted laparoscopic surgery: are we protecting our children?

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Abstract

Little is known about the effects of CO2 insufflation (CDI) on cerebral oxygen saturation (CrSO2) during laparoscopy in the pediatric population. In children undergoing robotic-assisted laparoscopic pyeloplasty (RALP), we prospectively assessed the effects of CDI using standard monitoring and cerebral near-infrared spectroscopy (NIRS). We also explored whether a correlation existed between CrSO2 and parameters known to affect cerebral blood flow. Between January 2021 and September 2023, a cohort of consecutive children older than 2 years underwent RALP at Necker-Enfants Malades Hospital in Paris. A ventilation protocol aimed to prevent hypercarbia was implemented. Data collected included standard monitoring parameters and CrSO2 by NIRS. Thirty patients (16 females), mean age 5.5 ± 3.9 (2.0–9.5) years, were included. Twenty-three patients underwent a retroperitoneal approach. The mean baseline CrSO2 value was 83.0 ± 9.8. Mean CrSO2 decreased during progressive CDI, never below baseline values, while standard-monitoring parameters did not significantly change. No significant correlation was detected between CrSO2 and end tidal CO2, or between CrSO2 and mean arterial pressure, at any operative time. During RALP, a gradual CDI doesn’t cause pathological derangements of CrSO2. The lack of correlation between CrSO2 and standard parameters affecting cerebral blood flow suggests the likely presence of cerebral autoregulation in our population.

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No datasets were generated or analysed during the current study.

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Acknowledgements

The authors thank Sandra Colas and Sarah Bouchard (URC/CIC Necker Cochin, Paris, France) for their help in managing the protocol and collecting the data and Doctor Paolo Setti Carraro for writing assistance and for reviewing the manuscript. We would like to thank all staff from the Pediatric Anaesthesia Department and Pediatric Surgery Department at Hopital Universitaire Necker Enfants Malades for their support in this study.

Funding

The project was funded by a grant from Necker-Enfants Malades Hospital. The sponsor played no direct role in the study.

Author information

Authors and Affiliations

  1. Department of Pediatric and Obstetrical Anesthesia and Critical Care, Hôpital Universitaire Necker Enfants Malades, 149, Rue de Sèvres, 75015, Paris, France

    Stefania Franzini, Stefania Querciagrossa, Myriam Brebion, Cristina Lapenta & Gilles Orliaguet

  2. Department of Pediatric Surgery and Urology, Hôpital Universitaire Necker Enfants Malades, Paris, France

    Thomas Blanc

  3. Université Paris Cité, Paris, France

    Thomas Blanc & Gilles Orliaguet

  4. Pharmacologie et Évaluation des Thérapeutiques chez l’enfant et la Femme Enceinte, Unité de Recherche EA 7323, Hôpitaux Universitaires Paris Centre—Site Tarnier Université Paris Cité, 75006, Paris, France

    Gilles Orliaguet

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  1. Stefania Franzini
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  2. Stefania Querciagrossa
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  3. Myriam Brebion
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  4. Cristina Lapenta
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  5. Thomas Blanc
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  6. Gilles Orliaguet
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Contributions

SF, SQ, TB, GO: study design. SF, SQ, MB: data acquisition. SF, SQ, TB, GO: patient recruitment, data collection, analysis and interpretation of data. SF, GO, MB, TB, SQ, CL: writing of the first draft of the paper. All authors: article revision. All authors: final approval of the version of the manuscript to be submitted.

Corresponding author

Correspondence to Stefania Franzini.

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Conflict of interest

Thomas Blanc is an official proctor for Intuitive Surgical.

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Franzini, S., Querciagrossa, S., Brebion, M. et al. Expanding safety boundaries in pediatric robotic-assisted laparoscopic surgery: are we protecting our children?. J Robotic Surg 18, 185 (2024). https://doi.org/10.1007/s11701-024-01959-x

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  • DOI: https://doi.org/10.1007/s11701-024-01959-x

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