Safe and optimal pneumoperitoneal pressure for transperitoneal laparoscopic renal surgery in infant less than 10 kg, looked beyond intraoperative period: A prospective randomized study

Sureka, Sanjoy Kumar; Patidar, Nitesh; Mittal, Varun; Kapoor, Rakesh; Srivastava, Aneesh; Kishore, Kamal; Dhiraj, Sanjay; Ansari, M.K.

doi:10.1016/j.jpurol.2016.01.014

Cited by 12 publications

(12 citation statements)

References 13 publications

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“…At T3, most of the parameters statistically restored back to baseline in Group I but not in Group II. Number of required adjustments in ventilatory parameters were 14 vs. 25 events in Group I vs. Group II ( p = 0.007, R = 0.552) 21 . Mean postoperative pain score, requirement for analgesia, and time to resume feeding were significantly greater in Group II 21 .…”

Section: Ral Infant Physiology and Anesthesiamentioning

confidence: 92%

“…In a prospective, randomized study, 46 infants (less than 10 kilograms in weight) who underwent RAL surgery were analyzed based on physiologic changes and pneumoperitoneal pressure (PP) (Group I, n = 23, PP = 6–8 mmHg and Group II, n = 23, PP = 9–10 mmHg) 21 . Hemodynamic, respiratory, and blood gas changes were measured at four points: before CO 2 insufflation (T0), 10 min after insufflation (T1), before desufflation (T2) and 10 min after desufflation (T3) 21 . Recorded outcomes included required adjustments of ventilator parameters, postoperative pain, analgesic use and time to resume feedings at 1, 6 and 12 h postoperatively.…”

Section: Ral Infant Physiology and Anesthesiamentioning

confidence: 99%

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Review of robot‐assisted laparoscopic surgery in management of infant congenital urology: Advances and limitations in utilization and learning

Lombardo

Gundeti

2022

Int J of Urology

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As robotic-assisted (RAL) surgery expanded to treat pediatric congenital disease, infant anatomy and physiology posed unique challenges that prompted adaptations to the technology and surgical technique, which are compiled and reviewed in this manuscript. From the beginning, collaboration with anesthesia is critical for a safe, efficient case including placement of an endotracheal tube rather than a laryngeal mask (LMA) and placement of a nasogastric tube and/or rectal tube to relieve distended stomach or bowel, respectively. Furthermore, end-tidal CO 2 (EtCO 2 ) is important for monitoring and predicting the effects of pneumoperitoneum on caridiovascular physiology, incranial pressure, and risk of acidosis and hypercarbia. Positioning can further exacerbate these effects and affect intra-abdominal working space. For infant robotic pyeloplasty and heminephrectomy, a "beanbag" is commonly used for stabilization in the lateral decubitus position. We advise against the use of a "baby bump" because it brings the bowels and vasculature more anterior than expected. Pnuemoperitoneum pressure of 8-10 mmHg during port placement maximizes safety, but thereafter, the pneumoperitoneum pressure can be minimized to 6-8 mmHg during the procedure without compromising the visual field. Port sites should be marked after insufflation, followed by the open Hasson technique for peritoneal access and port placement under direct vision with intussusception of the trocars to avoid vascular or bowel injury. Additional tips can be obtained through this manuscript, immersive fellowships, and mini-fellowships. Ulitmately, infant robotic surgery has the potential to benefit many children but is presently limited by the lack of pediatric-specific robotic technology and its associated costs.

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Section: Ral Infant Physiology and Anesthesiamentioning

confidence: 92%

Section: Ral Infant Physiology and Anesthesiamentioning

confidence: 99%

Review of robot‐assisted laparoscopic surgery in management of infant congenital urology: Advances and limitations in utilization and learning

Lombardo

Gundeti

2022

Int J of Urology

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“…Navarrete Arellano and Garibay González18 performed various operations on the young infants with a 3 cm interval between each trocar without any problems. (5) Anesthesia in minimally invasive endoscopic surgery cannot be ignored, especially for infants and neonates with poor cardiopulmonary tolerance and strong peritoneal absorption, which can easily absorb CO 2 and lead to hypercapnia, affecting cardiopulmonary and brain functions 19 20. Therefore, it is necessary to accurately regulate airway inflation pressure and oxygen concentration, which is also a major challenge in pediatric surgery.…”

Section: Overviewmentioning

confidence: 99%

Application and prospects of robotic surgery in children: a scoping review

Shen

Tou

2022

World Jnl Ped Surgery

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As an innovative minimally invasive surgical technology, robot-assisted surgery (RAS) has greatly improved the accuracy and safety of surgery through the advantages of three-dimensional magnification, tremor filtering, precision and flexibility, and has been carried out by an increasing number of surgeries. In recent years, robots have been gradually applied to children, bringing new ideas and challenges to pediatric surgeons. This review will describe the advantages and limitations of robotic surgery in children, summarize its application in pediatric surgery, and provide an outlook. It is believed that clinicians should actively carry out RAS under the premise of rigorously ensuring surgical indications and strive to improve the efficacy of surgical treatment for children.

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“…A prospective single-blind randomized study conducted in infants less than 10 kg undergoing pneumoperitoneum for laparoscopic renal surgery showed that an insufflation pressure between 6 and 8 mmHg provides excellent surgical conditions with minimal physiologic impact [78]. Transperitoneal insufflation pressures up to 10 mmHg do not induce significant hemodynamic changes [9,71,79], while insufflation pressures greater than 10 mmHg do not increase workspace in infants [64].…”

Section: Pneumoperitoneum and Ventilation Strategiesmentioning

confidence: 99%

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

et al. 2022

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Background Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally. Methods A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place. Results During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management. Conclusion Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.

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Safe and optimal pneumoperitoneal pressure for transperitoneal laparoscopic renal surgery in infant less than 10 kg, looked beyond intraoperative period: A prospective randomized study

Cited by 12 publications

References 13 publications

Review of robot‐assisted laparoscopic surgery in management of infant congenital urology: Advances and limitations in utilization and learning

Review of robot‐assisted laparoscopic surgery in management of infant congenital urology: Advances and limitations in utilization and learning

Application and prospects of robotic surgery in children: a scoping review

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

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