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Surgical Endoscopy

Published in:

01-10-2008

Minimally invasive surgery in infants less than 5 kg: experience of 649 cases

Authors: Todd A. Ponsky, Steven S. Rothenberg

Published in: Surgical Endoscopy | Issue 10/2008

Abstract

Introduction

With the development of advanced skills and the introduction of miniature laparoscopic tools, endoscopic procedures in infants and small children have become possible. This report documents our experience in minimally invasive surgery (MIS) in infants under 5 kg.

Methods

A retrospective database review was performed from September 1993 to September 2007. All children weighing 5 kg or less that underwent a laparoscopic or thoracoscopic procedure were included.

Results

A total of 649 cases were attempted. 43 different procedures were performed, the most common being Nissen fundoplication (310 cases, average opearting room (OR) time 43 min, average time to full feeds 2 days), pyloromyotomy (104 cases, average OR time 12.5 min, average hospital days <1), patent ductus arteriosum (PDA) ligation (26 cases, average OR time 31 min, average hospital days <1), tracheoesophageal fistula (TEF) repair (22 cases, average OR time 83 min, average time to full feeds 7.8 days), duodenoduodenostomy (20 cases, average OR time 76 min, average time to full feeds 8.6 days), colonic pull-through for Hirschsprung’s disease (18 cases, average OR time 109.6 min, average time to full feeds 3 days), colonic pull-through for imperforate anus (10 cases, average OR time 103 min, average hospital days 2), lung resection (12 cases, average OR time 66.8 min, average hospital days 1.75), congenital diaphragmatic hernia repair (10 cases, average OR time 62.5 min, average time to full feeds 4.75 days). There were no surgery-related deaths. The conversion rate to open was 1.2% (n = 8). There were six intraoperative complication rate (0.9%) and the overall complication rate was 3% (20 complications overall).

Conclusions

The development of modern low-flow CO₂ insufflators, smaller instruments and telescopes, as well as advanced techniques, has made MIS in neonates feasible and safe. The greatest challenge remains performing intestinal anastomosis in these confined spaces, and further technical advances will be required to make these techniques universally adopted.

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Title: Minimally invasive surgery in infants less than 5 kg: experience of 649 cases
Authors: Todd A. Ponsky
Steven S. Rothenberg
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 10/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-008-0025-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimally invasive surgery in infants less than 5 kg: experience of 649 cases

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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