GASLESS LAPAROSCOPY IN INFANTS - THE RABBIT MODEL

Laparoscopic operations can be performed in neonates and infants, but carbon dioxide pneumoperitoneum may be more dangerous than in adults. Therefore the concept of gasless laparoscopy is especially attractive for small children. The authors have developed an animal training mode l of gasless infant laparoscopy using the rabbit. Eleven New Zealand w hite rabbits (mean weight, 2.2 kg) were premedicated with fentanyl (10 mu g intramuscularly) and maintained under inhalation anesthesia by m ask, with halothane (1.0 to 2.5%) in oxygen and nitrous oxide (1:1). T he animals were neither intubated nor mechanically ventilated. Heart r ate and oxygen saturation were monitored by pulse oximetry. A supraumb ilical incision was made through the peritoneum, and an abdominal wall elevator was inserted. A 4-mm-diameter 30 degrees endoscope was intro duced at the same site, allowing excellent visualization of the abdomi nal cavity. Three additional 5-mm cannulas were placed, and a standard Nissen fundoplication was performed in all 11 animals. In seven of th ese, a left nephrectomy was also performed. Five millimeter pediatric instruments and 1.7- and 2.7-mm laryngoscopic instruments were used. T he rabbit can serve as a training model for laparoscopy in the infant. Gasless laparoscopy, using abdominal wall elevation, may be particula rly useful in very small patients. Copyright (C) 1995 by W.B. Saunders Company