Laparoscopic surgery in newborn infants

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 .