Minimal invasive surgery in the newborn: Current status and evidence

Laparoscopic repair of bladder rupture in a neonate

“…9 Although endoscopic surgery for neonatal patients is becoming popular, and large series could show the safety and feasibility of various procedures, there has been no reported case of bladder rupture repair in neo- nates. 10 In the present case, we could have placed a catheter into the bladder through the urethral valve before operation and treated the patient by bladder decompression alone. However, we chose to carry out laparoscopic repair, because there was no evidence of pulmonary hypoplasia in his preoperative respiratory status, and the procedure has the advantage of closure of the perforated site more certainly than bladder decompression alone, and with better cosmesis than open repair.…”

“…As an option of surgical repair for bladder rupture in recent years, laparoscopic management has become popular in the adult population, and some pediatric cases have been repaired laparoscopically . Although endoscopic surgery for neonatal patients is becoming popular, and large series could show the safety and feasibility of various procedures, there has been no reported case of bladder rupture repair in neonates . In the present case, we could have placed a catheter into the bladder through the urethral valve before operation and treated the patient by bladder decompression alone.…”

Partial amniotic carbon dioxide insufflation for fetal surgery

“…Retrospective clinical studies report significant hypercapnia, acidosis, and decreased cerebral oxygen saturation during thoracoscopy with CO 2 insufflation to repair congenital diaphragmatic hernia and esophageal atresia in neonates . However, long‐term neurodevelopmental outcomes are lacking, and an overarching scarcity of high‐quality prospective evidence in this field limits data interpretation …”

“…71,73 In infants, there are some concerns with CO 2 insufflation for endoscopic procedures, including an age-dependent reduced capacity for CO 2 elimination and increased susceptibility to cardiovascular depression and hypotension in response to hypercapnia, compared with older children and adults. [74][75][76] Retrospective clinical studies report significant hypercapnia, acidosis, and decreased cerebral oxygen saturation during thoracoscopy with CO 2 insufflation to repair congenital diaphragmatic hernia and esophageal atresia in neonates. 77,78 However, long-term neurodevelopmental outcomes are lacking, and an overarching scarcity of high-quality prospective evidence in this field limits data interpretation.…”

Minimally invasive surgery in neonates

“…Yenidoğanların alveolar yüzey alanı vücut yüzey alanının 1/3'i olması nedeniyle oksijen kullanımı erişkinlere göre iki kat fazla olduğu bilinmektedir. Laparoskopi ve torakoskopi sırasında karbondioksitin yenidoğan fizyolojisinde ne gibi değişiklikler yaptığı tam olarak bilinmemektedir (1) . Deneysel ça-lışmalarda karbondioksit emiliminin fazla olduğu ve kardiovasküler sistemin karbondioksite daha duyarlı olduğu gösterilmiştir (2,3) .…”