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Minimally invasive surgery in infants less than 5 kg: experience of 649 cases

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Abstract

Introduction

With the development of advanced skills and the introduction of miniature laparoscopic tools, endoscopic procedures in infants and small children have become possible. This report documents our experience in minimally invasive surgery (MIS) in infants under 5 kg.

Methods

A retrospective database review was performed from September 1993 to September 2007. All children weighing 5 kg or less that underwent a laparoscopic or thoracoscopic procedure were included.

Results

A total of 649 cases were attempted. 43 different procedures were performed, the most common being Nissen fundoplication (310 cases, average opearting room (OR) time 43 min, average time to full feeds 2 days), pyloromyotomy (104 cases, average OR time 12.5 min, average hospital days <1), patent ductus arteriosum (PDA) ligation (26 cases, average OR time 31 min, average hospital days <1), tracheoesophageal fistula (TEF) repair (22 cases, average OR time 83 min, average time to full feeds 7.8 days), duodenoduodenostomy (20 cases, average OR time 76 min, average time to full feeds 8.6 days), colonic pull-through for Hirschsprung’s disease (18 cases, average OR time 109.6 min, average time to full feeds 3 days), colonic pull-through for imperforate anus (10 cases, average OR time 103 min, average hospital days 2), lung resection (12 cases, average OR time 66.8 min, average hospital days 1.75), congenital diaphragmatic hernia repair (10 cases, average OR time 62.5 min, average time to full feeds 4.75 days). There were no surgery-related deaths. The conversion rate to open was 1.2% (n = 8). There were six intraoperative complication rate (0.9%) and the overall complication rate was 3% (20 complications overall).

Conclusions

The development of modern low-flow CO2 insufflators, smaller instruments and telescopes, as well as advanced techniques, has made MIS in neonates feasible and safe. The greatest challenge remains performing intestinal anastomosis in these confined spaces, and further technical advances will be required to make these techniques universally adopted.

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References

  1. Alain JL, Grousseau D, Terrier G (1991) Extramucosal pyloromyotomy by laparoscopy. Surg Endosc 5(4):174–175

    Article  PubMed  CAS  Google Scholar 

  2. Najmaldin A, Tan HL (1995) Early experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis. J Pediatr Surg 30(1):37–38

    Article  PubMed  CAS  Google Scholar 

  3. Hamada Y, Tsui M, Kogata M, Hioki K, Matsuda T (1995) Surgical technique of laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis. Surg Today 25(8):754–756

    Article  PubMed  CAS  Google Scholar 

  4. Lobe TE, Schropp KP, Lunsford K (1993) Laparoscopic Nissen fundoplication in childhood. J Pediatr Surg 28(3):358–60; discussion 360–361

    Article  PubMed  CAS  Google Scholar 

  5. Rothenberg SS (2002) Laparoscopic duodenoduodenostomy for duodenal obstruction in infants and children. J Pediatr Surg 37(7):1088–1089

    Article  PubMed  Google Scholar 

  6. van der Zee DC, Bax NM (1995) Laparoscopic repair of acute volvulus in a neonate with malrotation. Surg Endosc 9(10):1123–1124

    Article  PubMed  Google Scholar 

  7. Frantzides CT, Cziperle DJ, Soergel K, Stewart E (1996) Laparoscopic ladd procedure and cecopexy in the treatment of malrotation beyond the neonatal period. Surg Laparosc Endosc 6(1):73–75

    Article  PubMed  CAS  Google Scholar 

  8. Waldhausen JH, Sawin RS (1996) Laparoscopic Ladd’s procedure and assessment of malrotation. J Laparoendosc Surg 6(Suppl 1):S103–S105

    PubMed  Google Scholar 

  9. Gross E, Chen MK, Lobe TE (1996) Laparoscopic evaluation and treatment of intestinal malrotation in infants. Surg Endosc 10(9):936–937

    Article  PubMed  CAS  Google Scholar 

  10. Georgeson KE (1993) Laparoscopic gastrostomy and fundoplication. Pediatr Ann 22(11):675–677

    PubMed  CAS  Google Scholar 

  11. Stylianos S, Flanigan LM (1995) Primary button gastrostomy: a simplified percutaneous, open, laparoscopy-guided technique. J Pediatr Surg 30(2):219–220

    Article  PubMed  CAS  Google Scholar 

  12. Rothenberg SS (1994) Laparoscopic anti-reflux procedures and gastrostomy tubes in infants and children. Int Surg 79(4):328–331

    PubMed  CAS  Google Scholar 

  13. Georgeson KE, Fuenfer MM, Hardin WD (1995) Primary laparoscopic pull-through for Hirschsprung’s disease in infants and children. J Pediatr Surg 30(7):1017–1021; discussion 1021–1022

    Article  PubMed  CAS  Google Scholar 

  14. Vick LR, Gosche JR, Boulanger SC, Islam S (2007) Primary laparoscopic repair of high imperforate anus in neonatal males. J Pediatr Surg 42(11):1877–1881

    Article  PubMed  Google Scholar 

  15. Tang S, Dong N, Tong Q, Wang Y, Mao Y (2007) Laparoscopic assisted endorectal pull-through with posterior sagittal approach to the repair of postoperative rectourethral and rectovaginal fistula. Pediatr Surg Int 23(11):1077–1080

    Article  PubMed  Google Scholar 

  16. Rothenberg S, Holcomb G, Georgeson K, Irish M, Lucas E, Blinman T (2007) Web-based live telesurgery for minimally invasive procedures in children as an educational tool. J Laparoendosc Adv Surg Tech A 17(2):226–229

    Article  PubMed  Google Scholar 

  17. Lima M, Tursini S, Ruggeri G, Aquino A, Gargano T, De Biagi L, Ahmed A, Gentili A (2006) Laparoscopically assisted anorectal pull-through for high imperforate anus: three years’ experience. J Laparoendosc Adv Surg Tech A 16(1):63–66

    Article  PubMed  Google Scholar 

  18. Koivusalo A, Pakarinen M, Rintala RJ (2006) Are cecal wrap and fixation necessary for antegrade colonic enema appendicostomy? J Pediatr Surg 41(2):323–326

    Article  PubMed  Google Scholar 

  19. Kudou S, Iwanaka T, Kawashima H, Uchida H, Nishi A, Yotsumoto K, Kaneko M (2005) Midterm follow-up study of high-type imperforate anus after laparoscopically assisted anorectoplasty. J Pediatr Surg 40(12):1923–1926

    Article  PubMed  Google Scholar 

  20. Kubota A, Kawahara H, Okuyama H, Oue T, Tazuke Y, Tanaka N, Okada A (2005) Laparoscopically assisted anorectoplasty using perineal ultrasonographic guide: a preliminary report. J Pediatr Surg 40(10):1535–1538

    Article  PubMed  Google Scholar 

  21. Holcomb GW 3rd, Rothenberg SS, Bax KM, Martinez-Ferro M, Albanese CT, Ostlie DJ, van Der Zee DC, Yeung CK (2005) Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis. Ann Surg 242(3):422–428; discussion 428–430

    PubMed  Google Scholar 

  22. Levitt MA, Pena A (2005) Outcomes from the correction of anorectal malformations. Curr Opin Pediatr 17(3):394–401

    Article  PubMed  Google Scholar 

  23. Koga H, Okazaki T, Yamataka A, Kobayashi H, Yanai T, Lane GJ, Miyano T (2005) Posterior urethral diverticulum after laparoscopic-assisted repair of high-type anorectal malformation in a male patient: surgical treatment and prevention. Pediatr Surg Int 21(1):58–60

    Article  PubMed  Google Scholar 

  24. Wong KK, Khong PL, Lin SC, Lam WW, Lan LC, Tam PK (2005) Post-operative magnetic resonance evaluation of children after laparoscopic anorectoplasty for imperforate anus. Int J Colorectal Dis 20(1):33–37

    Article  PubMed  CAS  Google Scholar 

  25. Lin CL, Wong KK, Lan LC, Chen CC, Tam PK (2003) Earlier appearance and higher incidence of the rectoanal relaxation reflex in patients with imperforate anus repaired with laparoscopically assisted anorectoplasty. Surg Endosc 17(10):1646–1649

    Article  PubMed  CAS  Google Scholar 

  26. Barqawi AZ, Blyth B, Jordan GH, Ehrlich RM, Koyle MA (2003) Role of laparoscopy in patients with previous negative exploration for impalpable testis. Urology 61(6):1234–1237; discussion 1237

    Article  PubMed  Google Scholar 

  27. Yamataka A, Yoshida R, Kobayashi H, Lane GJ, Kurosaki Y, Segawa O, Kameoka S, Miyano T (2002) Intraoperative endosonography enhances laparoscopy-assisted colon pull-through for high imperforate anus. J Pediatr Surg 37(12):1657–1660

    Article  PubMed  Google Scholar 

  28. Sydorak RM, Albanese CT (2002) Laparoscopic repair of high imperforate anus. Semin Pediatr Surg 11(4):217–225

    Article  PubMed  Google Scholar 

  29. Iwanaka T, Arai M, Kawashima H, Kudou S, Fujishiro J, Matsui A, Imaizumi S (2003) Findings of pelvic musculature and efficacy of laparoscopic muscle stimulator in laparoscopy-assisted anorectal pull-through for high imperforate anus. Surg Endosc 17(2):278–281

    Article  PubMed  CAS  Google Scholar 

  30. Gauderer MW, Decou JM, Boyle JT (2002) Sigmoid irrigation tube for the management of chronic evacuation disorders. J Pediatr Surg 37(3):348–351

    Article  PubMed  Google Scholar 

  31. Yamataka A, Segawa O, Yoshida R, Kobayashi H, Kameoka S, Miyano T (2001) Laparoscopic muscle electrostimulation during laparoscopy-assisted anorectal pull-through for high imperforate anus. J Pediatr Surg 36(11):1659–1661

    Article  PubMed  CAS  Google Scholar 

  32. Ng WT, Chang D (2001) Radially dilating trocars are not cost-effective alternatives except for pediatric laparoscopic operations, especially those for undescended testis and imperforate anus. Surg Endosc 15(4):424–425

    Article  PubMed  CAS  Google Scholar 

  33. Georgeson KE, Inge TH, Albanese CT (2000) Laparoscopically assisted anorectal pull-through for high imperforate anus-a new technique. J Pediatr Surg 35(6):927–930; discussion 930–931

    Article  PubMed  CAS  Google Scholar 

  34. Azuma T, Okada A (1997) [Management of anorectal malformations and Hirschsprung’s disease]. Nippon Geka Gakkai Zasshi 98(12):1023–1029

    PubMed  CAS  Google Scholar 

  35. Amara DP, Nezhat F, Giudice L, Nezhat C (1997) Laparoscopic management of a noncommunicating uterine horn in a patient with an acute abdomen. Surg Laparosc Endosc 7(1):56–59

    Article  PubMed  CAS  Google Scholar 

  36. van der Zee DC, Bax NM (1995) Laparoscopic repair of congenital diaphragmatic hernia in a 6–month-old child. Surg Endosc 9(9):1001–1003

    Article  PubMed  Google Scholar 

  37. Ponsky TA, Lukish JR, Nobuhara K, Powell D, Newman KD (2002) Laparoscopy is useful in the diagnosis and management of foramen of Morgagni hernia in children. Surg Laparosc Endosc Percutan Tech 12(5):375–377

    Article  PubMed  Google Scholar 

  38. Silen ML, Canvasser DA, Kurkchubasche AG, Andrus CH, Naunheim KS (1995) Video-assisted thoracic surgical repair of a foramen of Bochdalek hernia. Ann Thorac Surg 60(2):448–450

    Article  PubMed  CAS  Google Scholar 

  39. Sato Y, Ishikawa S, Onizuka M, Akaogi E, Mitsui K, Mitsui T (1996) Thoracoscopic repair of diaphragmatic hernia. Thorac Cardiovasc Surg 44(1):54–55

    Article  PubMed  CAS  Google Scholar 

  40. Bax KM, van Der Zee DC (2002) Feasibility of thoracoscopic repair of esophageal atresia with distal fistula. J Pediatr Surg 37(2):192–196

    Article  PubMed  Google Scholar 

  41. Rothenberg SS (2002) Thoracoscopic repair of tracheoesophageal fistula in newborns. J Pediatr Surg 37(6):869–872

    Article  PubMed  Google Scholar 

  42. Rothenberg SS (2000) Thoracoscopic lung resection in children. J Pediatr Surg 35(2):271–274; discussion 274–275

    Article  PubMed  CAS  Google Scholar 

  43. Gomola A, Gall O, Larroquet M, Constant I, Balquet P, Murat I (1997) Video-assisted thoracoscopic surgery for right middle lobectomy in children. Paediatr Anaesth 7(3):215–220

    Article  PubMed  CAS  Google Scholar 

  44. Rothenberg SS, Wagner JS, Chang JH, Fan LL (1996) The safety and efficacy of thoracoscopic lung biopsy for diagnosis and treatment in infants and children. J Pediatr Surg 31(1):100–103; discussion 103–104

    Article  PubMed  CAS  Google Scholar 

  45. Maehara T, Ohgami M, Kokaji K, Yamashita Y, Wakabayashi G, Nohga K (1993) [An innovative thoracoscopic surgery for patient ductus arteriosus-a Japanese first case report]. Nippon Kyobu Geka Gakkai Zasshi 41(9):1522–1527

    PubMed  CAS  Google Scholar 

  46. Rothenberg SS, Chang JH, Toews WH, Washington RL (1995) Thoracoscopic closure of patent ductus arteriosus: a less traumatic and more cost-effective technique. J Pediatr Surg 30(7):1057–1060

    Article  PubMed  CAS  Google Scholar 

  47. Rothenberg SS (2006) Laparoscopic redo Nissen fundoplication in infants and children. Surg Endosc 20(10):1518–1520

    Article  PubMed  CAS  Google Scholar 

  48. Rothenberg SS, Chang JH, Bealer JF (1998) Experience with minimally invasive surgery in infants. Am J Surg 176(6):654–658

    Article  PubMed  CAS  Google Scholar 

  49. 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(6):608–612

    Article  PubMed  CAS  Google Scholar 

  50. Iwanaka T, Uchida H, Kawashima H, Nishi A, Kudou S, Satake R (2004) Complications of laparoscopic surgery in neonates and small infants. J Pediatr Surg 39(12):1838–1841

    Article  PubMed  Google Scholar 

  51. Wilkins BM, Spitz L (1987) Adhesion obstruction following Nissen fundoplication in children. Br J Surg 74(9):777–779

    Article  PubMed  CAS  Google Scholar 

  52. Diamond IR, Herrera P, Langer JC, Kim PC (2007) Thoracoscopic versus open resection of congenital lung lesions: a case-matched study. J Pediatr Surg 42(6):1057–1061

    Article  PubMed  Google Scholar 

  53. Fuchs J, Kirschner HJ, Warmann SW, Schellinger K, Baden W, Szavay P (2007) [Thoracoscopic anatomical lung resection in children]. Zentralbl Chir 132(3):247–250

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Rocky Mountain Hospital for Children, Denver, CO, USA

    Todd A. Ponsky & Steven S. Rothenberg

  2. Division of Pediatric Surgery, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA

    Todd A. Ponsky

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  1. Todd A. Ponsky
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  2. Steven S. Rothenberg
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Correspondence to Todd A. Ponsky.

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Ponsky, T.A., Rothenberg, S.S. Minimally invasive surgery in infants less than 5 kg: experience of 649 cases. Surg Endosc 22, 2214–2219 (2008). https://doi.org/10.1007/s00464-008-0025-7

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  • DOI: https://doi.org/10.1007/s00464-008-0025-7

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