Laparoscopic surgery in newborn infants

Fujimoto, Toshio; Segawa, Osamu; Lane, Geoffrey J.; Esaki, Saori; Miyano, Takeshi

doi:10.1007/s004649901096

Cited by 93 publications

(51 citation statements)

References 17 publications

(18 reference statements)

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“…No hemodynamic instability in newborns was reported with an insufflation pressure of 8 mm Hg. 10 In our series, the systemic arterial pressure was overall stable. The variation was null or Ͻ5 mm Hg in 80% of the cases.…”

Section: Discussionmentioning

confidence: 47%

“…It may expose the infant to the risk of per-operative acidosis and alteration of the cerebral circulation because it is correlated with high CO 2 arterial pressure and low pH. 17,18 For controlling ETCO 2 and counterbalancing a reduced respiratory compliance induced by insufflation, 19 a great increase in ventilatory minute volume (22.6% in our series, 40% for Fujimoto 10 ) and PIP was essential. However, it was applied to neonatal lungs that are highly sensitive to both volume and pressure.…”

Section: Discussionmentioning

confidence: 68%

“…Although it has been difficult to prove that infants who undergo this technique have a shorter and simpler postoperative course, some indications such as the fundoplication 5 have clearly shown better cosmetic results and more rapid recovery. Neonates, however, have distinct physiologic and anatomic characteristics that increase the rate of surgical complica- 10 This study was designed to evaluate the repercussions of CO 2 insufflation in infants who are younger than 1 month and to determine the characteristics of patients who are at risk for complication. Neonatal ventilatory limitations, particularly the small airway caliber and the important instrumental deadspace, could explain the markedly perturbed gas exchanges noted in our series.…”

Section: Discussionmentioning

confidence: 99%

“…9 Nevertheless, the potential impact of carbon dioxide pneumoperitoneum and pneumothorax on an immature neonatal cardiopulmonary system is a matter of great concern. Relatively few studies reporting on the cardiorespiratory consequences have been published, 10 and most of those that support the feasibility and the safety of these methods in the first month of life are case reports or short clinical series. The advent of this new surgical procedure in such young children, given their cardiovascular, pulmonary, and thermoregulatory specificities, nevertheless requires a thorough evaluation of its tolerance.…”

mentioning

confidence: 99%

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Tolerance of Laparoscopy and Thoracoscopy in Neonates

et al. 2005

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ABSTRACT. Objectives. Video-surgery in neonates is recent. Data on the respiratory, hemodynamic, and thermic effects during the first month of life are still sparse. This study aimed to evaluate the tolerance of videosurgery in neonates and to determine the risk factors of per-operative complications.Methods. From 1994 to 2004, 49 neonates (mean age: 11 days; weight: 3285 g) underwent 50 video-surgical procedures. Indications for laparoscopy were duodenal atresias, volvulus with malrotation, pyloric stenosis, gastroesophageal reflux, cystic lymphangiomas, ovarian cysts, biliary atresia, and congenital diaphragmatic hernias; indications for thoracoscopy were esophageal atresias and tracheoesophageal fistula.Results. Median operative time was 79 minutes. Mean insufflation pressure was 6.7 mm Hg (range: 3-13). Oxygen saturation decreased, especially with thoracic insufflation or high-pressure pneumoperitoneum. Systolic arterial pressure, which decreased in 20% of the patients, was controlled easily with vascular expansion. Thermic loss (mean postoperative temperature: 35.6°C) was proportional to the duration of insufflation. No surgical incident was noted. Ten anesthetic incidents occurred (20%), 3 of which required temporary or definitive interruption of insufflation (O 2 saturation <70%). Risk factors for an incident were low preoperative temperature, high variation of end-tidal pressure of CO 2 , surgical time >100 minutes, thoracic insufflation, and a high oxygen or vascular expansion requirement at the beginning of insufflation.Conclusion. The neonate's high sensitivity to insufflation is an important limiting factor of video-surgery. ABBREVIATIONS. ETCO 2 , end-tidal pressure of CO 2 ; O 2 sat, oxygen saturation; HR, heart rate; PIP, peak inflating pressure.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Tolerance of Laparoscopy and Thoracoscopy in Neonates

et al. 2005

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“…Laparoscopy reveals a misdiagnosis rate of 8% in male, and 41% in female of reproductive age group. [54,55]. Laparoscopic appendectomy gives a better evaluation of the peritoneal cavity than that obtained by the standard grid-iron exposure.…”

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confidence: 99%

Laparoscopic versus Open Appendectomy for the Treatment of Acute Appendicitis

Mishra¹,

Hanna²,

Cuschieri³

2008

WJOLS

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Abstract::Open appendectomy is the 'gold standard' for the treatment of acute appendicitis. Laparoscopic appendectomy though widely practiced has not gained universal approval. Although it is a generally safe operation, postoperative complications occur in few patients. Laparoscopic appendectomy was first described in 1983. Reports of early studies were equivocal with few studies evaluating analgesic requirements and the length of hospital stay. This study was aimed to compare laparoscopic with open appendectomy and ascertain the therapeutic benefit, if any, in the overall management of acute appendicitis. Key words:Laparoscopic appendectomy, Appendectomy, Appendicitis, Laparoscopic vs. open appendectomy Introduction:

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