Feasibility of complex minimally invasive surgery in neonates

The aim of this study was to assess the feasibility of complex minimally invasive surgery in neonates (and infants <5 kg). A systematic search of databases was performed. Inguinal herniotomy and pyloromyotomy were specifically excluded. Various operations were assessed for operative times, conversion rates, complications and centres performing the procedures. From 479 abstracts, 50 papers were identified describing 1,215 patients. Common operations performed were fundoplication (n = 473), operations for ovarian pathology (n = 151) and oesophageal atresia repair (n = 123). Other not-so-common operations included Kasai procedure (n = 61), Ladd's procedure (n = 55), bowel atresia surgery (n = 45) and congenital diaphragmatic hernia repair (n = 41). Mean operation times varied from 43 min for fundoplication to 209 min for Kasai procedure, with other operation times falling in between the two extremes. Likewise, conversion rates varied from 0.2% for fundoplication to 15% for congenital diaphragmatic hernia, with other conversion rates falling in between. Complications ranged from 0 to 67%. About 70-94% of the cases were performed in six pioneering centres. Fundoplication and operations for ovarian pathology have low complication and conversion rates and appear to be well suited to the average-trained paediatric laparoscopic surgeon. More complex procedures are feasible and safe, but technically demanding and need further expertise.