Background: Thanks to various technical innovations and advances in instrum
entation, laparoscopic surgical intervention is now possible for certain co
ngenital anomalies in children. To test the applicability of laparoscopic s
urgery in neonates, we reviewed our personal experience of neonatal laparos
copic surgery, focusing on cardiopulmonary function, surgical procedures, p
roblems with devices, and degree of associated surgical stress.
Methods: We performed 65 laparoscopic procedures in neonates. Their ages ra
nged from 2 to 30 days old, and their body weights ranged from 1,980 to 4,7
80 g. All 65 laparoscopic procedures were carried out without mortality or
serious morbidity.
Results: As complications, we encountered four cases of hypothermia due to
rapid insufflation of carbon dioxide (CO2). We also found that relative hyp
ercapnea (increase in end-tidal CO2 as high as 61 mmHg) developed unless hy
perventilation and a relatively high peak insufflation pressure were mainta
ined during pneumoperitoneum. No cardiac depression developed at this insuf
flation pressure. Fluid and electrolyte balance during our cases of newborn
laparoscopic surgery, as well as the doses and volumes of fluid and electr
olytes administered, were identical to those required for open surgery. Int
erleukin-6 (IL-6) was measured serially to estimate the degree of associate
d surgical stress and was found to be significantly lower in neonates who h
ad received laparoscopic procedures than in those who had received open pro
cedures.
Conclusion: Laparoscopic surgery can be carried out safely even in neonates
.