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Minimal access surgery in neonates and infants
Aayed R Al-Qahtani1, Hamdi Almaramhi
1Division of Pediatric Surgery, King Khalid University Hospital, Riyadh 11472, Saudi Arabia. qahtani@yahoo.com
Insights
Minimal access surgery (MAS) is safe and well-tolerated in neonates and infants. Careful monitoring of end-tidal CO2 and core temperature is crucial for successful outcomes in these young patients.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Procedures
- Neonatal Care
Background:
- Minimal access surgery (MAS) presents unique challenges in small infants due to physiological considerations and required expertise.
- Performing MAS in neonates and infants has been difficult in many international centers.
Purpose of the Study:
- To review the experience with MAS in neonates and infants within the first year of life.
- To evaluate the safety and outcomes of MAS in this vulnerable population.
Main Methods:
- Retrospective review of medical records for neonates and infants (<1 year) undergoing MAS over 3 years.
- Procedures utilized 3-mm instruments and scopes with a mean insufflation pressure of 10 mm Hg.
Main Results:
- Seventy infants (24 neonates) underwent various procedures including tracheoesophageal fistula repair, lobectomy, and hernia repair.
- All patients tolerated MAS well; 2 conversions occurred in neonates with tracheoesophageal fistula.
- Minor complications included hypothermia and elevated PCO2 in 2 neonates; 1 mortality and no morbidities were reported.
Conclusions:
- Minimal access surgery is a safe and well-tolerated procedure for neonates and infants.
- Intraoperative monitoring of end-tidal CO2 and core temperature is essential to prevent adverse effects, particularly in neonates.
Background:
Minimal access surgery (MAS) in small infants carries an important consideration. The tolerance of these small babies and the assumed physiological effect of MAS, in addition to the required anesthetic and surgical skills, have made it difficult to perform these types of procedures in many international centers. The present article reviews our experience with MAS in neonates and infants in the first year of life.
Methods:
The medical records of all neonates and infants (<1 year) who underwent MAS over a period of 3 years were retrospectively reviewed for demographic information, procedures, operative time, complications, outcomes, and follow-up. Most of the operations were performed with 3-mm instruments and scopes and mean insufflation pressure of 10 mm Hg (range, 4-15 mm Hg).
Result:
Seventy neonates and infants were included in this study: 19 females and 51 males. The weight ranged from 1.3 to 8.2 kg (mean, 4.3 kg). The mean age was 93 days (range, 1 day to 12 months). Twenty-four (34%) were neonates (first 30 days of life). Procedures performed included repair of tracheoesophageal fistula, lobectomy, repair of diaphragmatic or hiatus hernias, pull-through for imperforated anus and Hirschsprung's disease, plication of the diaphragm, Kasai procedure, excision of choledochal cyst, pyloromyotomy, Ladd's procedure, and reduction of intussusceptions. There were 2 conversions, both in neonates with tracheoesophageal fistula. All patients tolerated the procedure very well, with lesser degrees in neonates undergoing thoracoscopic procedures. Two neonates had postoperative hypothermia (<35 degrees C) and 1 neonate had high PCO2 postoperatively. There was 1 mortality and no morbidities. The follow-up ranged from 1 month to 3 years (mean, 19 months).
Conclusion:
Minimal access surgery in neonates and infants is safe and well tolerated. Intraoperative monitoring of end-tidal CO2 and core temperature is essential in avoiding unwanted effects of performing these procedures, especially in neonates.
