BACKGROUND: Complex procedures for managing congenital abnormalities are reported to be feasible. However, neonatal videosurgery involves very specific physiologic constraints. This study evaluated the safety and complication rate of videosurgery during the first month of life and sought to determine both the risk factors of perioperative complications and the most recent trends in practice. METHODS: From 1993 to 2005, 218 neonates (mean age, 16 days; weight, 3,386 g) from seven European university hospitals were enrolled in a retrospective study. The surgical indications for laparoscopy (n = 204) and thoracoscopy (n = 14) were congenital abnormalities or exploratory procedures. RESULTS: Of the 16 surgical incidents that occurred (7.5%), mainly before 2001, 11 were minor (parietal hematoma, eventration). Three neonates had repeat surgery for incomplete treatment of pyloric stenosis. In two cases, the incidents were more threatening (duodenal wound, diaphragmatic artery injury), but without further consequences. No mortality is reported. The 26 anesthetic incidents (12%) that occurred during insufflation included desaturation (<80% despite 100% oxygen ventilation) (n = 8), transient hypotension requiring vascular expansion (n = 7), hypercapnia (>45 mmHg) (n = 5), hypothermia (<34.9 degrees C) (n = 4), and metabolic acidosis (n = 2). The insufflation had to be stopped in 7% of the cases (transiently in 9 cases, definitively in 6 cases). The significant risk factors for an incident (p < 0.05) were young age of the patient, low body temperature, thoracic insufflation, high pressure and flow of insufflation, and length of surgery. CONCLUSION: Despite advances in miniaturizing of instruments and growth in surgeons' experience, the morbidity of neonatal videosurgery is not negligible. A profile of the patient at risk for an insufflation-related incident emerged from this study and may help in the selection of neonates who will benefit most from these techniques in conditions of maximal safety.
BACKGROUND: Complex procedures for managing congenital abnormalities are reported to be feasible. However, neonatal videosurgery involves very specific physiologic constraints. This study evaluated the safety and complication rate of videosurgery during the first month of life and sought to determine both the risk factors of perioperative complications and the most recent trends in practice. METHODS: From 1993 to 2005, 218 neonates (mean age, 16 days; weight, 3,386 g) from seven European university hospitals were enrolled in a retrospective study. The surgical indications for laparoscopy (n = 204) and thoracoscopy (n = 14) were congenital abnormalities or exploratory procedures. RESULTS: Of the 16 surgical incidents that occurred (7.5%), mainly before 2001, 11 were minor (parietal hematoma, eventration). Three neonates had repeat surgery for incomplete treatment of pyloric stenosis. In two cases, the incidents were more threatening (duodenal wound, diaphragmatic artery injury), but without further consequences. No mortality is reported. The 26 anesthetic incidents (12%) that occurred during insufflation included desaturation (<80% despite 100% oxygen ventilation) (n = 8), transient hypotension requiring vascular expansion (n = 7), hypercapnia (>45 mmHg) (n = 5), hypothermia (<34.9 degrees C) (n = 4), and metabolic acidosis (n = 2). The insufflation had to be stopped in 7% of the cases (transiently in 9 cases, definitively in 6 cases). The significant risk factors for an incident (p < 0.05) were young age of the patient, low body temperature, thoracic insufflation, high pressure and flow of insufflation, and length of surgery. CONCLUSION: Despite advances in miniaturizing of instruments and growth in surgeons' experience, the morbidity of neonatal videosurgery is not negligible. A profile of the patient at risk for an insufflation-related incident emerged from this study and may help in the selection of neonates who will benefit most from these techniques in conditions of maximal safety.
Authors: Eric J Hazebroek; Michiel A Schreve; Pim Visser; Ron W F De Bruin; Richard L Marquet; H Jaap Bonjer Journal: J Laparoendosc Adv Surg Tech A Date: 2002-10 Impact factor: 1.878
Authors: E J Hazebroek; J J Haitsma; B Lachmann; E W Steyerberg; R W F de Bruin; N D Bouvy; H J Bonjer Journal: Surg Endosc Date: 2002-04-09 Impact factor: 4.584
Authors: Hope T Jackson; Sohail R Shah; Emily Hathaway; Evan P Nadler; Richard L Amdur; Shannon McGue; Timothy D Kane Journal: Surg Endosc Date: 2015-10-19 Impact factor: 4.584
Authors: Marc Reismann; Johannes Gossner; Sylvia Glueer; Nicolaus Schwerk; Benno M Ure; Martin L Metzelder Journal: World J Pediatr Date: 2011-08-27 Impact factor: 2.764
Authors: Lisanne J Stolwijk; Stefaan H A J Tytgat; Kristin Keunen; Nutnicha Suksamanapan; Maud Y A van Herwaarden; Floris Groenendaal; Petra M A Lemmers; David C van der Zee Journal: Surg Endosc Date: 2014-12-09 Impact factor: 4.584
Authors: Cindy Gomes Ferreira; Olivier Reinberg; François Becmeur; Hossein Allal; Pascal De Lagausie; Hubert Lardy; Paul Philippe; Manuel Lopez; François Varlet; Guillaume Podevin; Jürgen Schleef; Max Schlobach Journal: Surg Endosc Date: 2009-03-05 Impact factor: 4.584