Related Experiment Video
Updated: Aug 18, 2026
Robot-Assisted Laparoscopic Splenectomy In Children: A Case Report with Literature Review
Published on: March 27, 2026
Hemodynamic and respiratory effects of robot-assisted laparoscopic fundoplication in children
Dirk Meininger1, Christian Byhahn, Stephan Mierdl
1Department of Anesthesiology, Intensive Care Medicine and Pain Control, J.W. Goethe-University Hospital, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany. dirk_meininger@gmx.de
Insights
Robot-assisted laparoscopic fundoplication in children using carbon dioxide pneumoperitoneum is well tolerated. Hemodynamic and respiratory changes are manageable, allowing for immediate extubation after surgery.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Cardiopulmonary Physiology
Background:
- Laparoscopic fundoplication is a common treatment for pediatric gastro-esophageal reflux disease.
- Carbon dioxide pneumoperitoneum can cause hemodynamic and respiratory changes during minimally invasive surgery.
Purpose of the Study:
- To evaluate the hemodynamic and respiratory effects of carbon dioxide pneumoperitoneum at 12 mmHg IAP.
- To assess tolerance and anesthetic management during robot-assisted laparoscopic fundoplication in children.
Main Methods:
- Ten pediatric patients (8-16 years, ASA II-III) undergoing robot-assisted laparoscopic fundoplication were studied.
- Hemodynamic (MAP, HR) and respiratory (MV, PIP, P(et)CO2, PaCO2, PaO2) parameters were monitored.
- Measurements were taken at six time points during and after pneumoperitoneum (12 mmHg IAP) under TIVA.
Main Results:
- Mean arterial pressure and minute ventilation significantly increased during pneumoperitoneum.
- Peak inspiratory pressure increased, while PaO2 and pH decreased.
- End-tidal and arterial CO2 increased, but were well tolerated.
Conclusions:
- Hemodynamic and respiratory effects of CO2 pneumoperitoneum at 12 mmHg IAP are well tolerated in children.
- Total intravenous anesthesia with remifentanil, propofol, and mivacurium facilitates early extubation.
- Robot-assisted laparoscopic fundoplication is a safe procedure in this pediatric population.
Abstract:
Laparoscopic fundoplication is increasingly used for treating gastro-esophageal reflux disease in children. Mechanical and pharmacological effects may contribute to hemodynamic and respiratory changes during carbon dioxide pneumoperitoneum. The aim of the present study was to evaluate the hemodynamic and respiratory effects of pneumoperitoneum (PP) with an intra-abdominal pressure (IAP) of 12 mmHg in children undergoing robot-assisted laparoscopic fundoplication during total intravenous anesthesia. Ten children, aged 8-16 years, American Society of Anesthesiologists physical status II-III, scheduled for robot-assisted laparoscopic fundoplication in the reverse Trendelenburg position were investigated. Minute ventilation (MV), peak inspiratory pressure (PIP), IAP, heart rate (HR), mean arterial blood pressure (MAP) were recorded, together with pH, base excess, HCO3-, P(et)CO2, PaCO2, and PaO2 at six time points: before insufflation, 10, 30, 60, 90 minutes after creating PP and after desufflation. The IAP was maintained at 12 mmHg. During insufflation MAP increased significantly from 70.6 (+/-9.0) to 84.8 (+/-10.4) mmHg, MV was increased from 4.6 (+/-0.8) to 5.5 (+/-0.9) l min(-1), PIP increased, PaO2 and pH decreased. P(et)CO2 increased from 33.1 (+/-1.6) to 36.6 (+/-1.6) mmHg together with PaCO2. Hemodynamic and respiratory effects due to the intra-abdominal insufflation of CO2 with an IAP of 12 mmHg are well tolerated, and anesthesia with remifentanil, propofol and mivacurium facilitates extubation immediately at the end of surgery.
