Experience with Advanced Endosurgical Procedures in Neonates and Infants

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Abstract
This report reviews the results of advanced endosurgical procedures in neonates and infants weighing less than 5 kg. Over a 2½-year period, 106 patients underwent 111 laparoscopic or thoracoscopic procedures. Ages ranged from 2 days to 20 weeks and weights from 1.5 to 5.0 kg. Procedures (numbers performed [n] and average operative times [t] in minutes) include Nissen fundoplication and gastrostomy (n = 58, t = 54), pyloromyotomy (n = 15, t = 15), patent ductus arteriosus (PDA) occlusion (n = 6, t = 50), pullthrough for Hirschsprung's disease (n = 4, t = 180, Ladd's procedure (n = 5, t = 65), ovarian cystectomy (n = 5, t = 35), lung biopsy (n = 5, t = 35), congenital diaphragmatic hernia repair (n = 3, t = 75), and other (n = 8, t = 12). The majority of procedures were performed with specially designed 3.4-mm instruments and a 2.7-mm 0° scope. Abdominal insufflation was kept at pressures of 10 to 14 mm Hg. All procedures were completed successfully endoscopically and the complication rate was 4.5%. The only death occurred after life support was removed after the results of a lung biopsy. Postoperative hospital stays were significantly shorter than standard open surgery (historical controls). This study demonstrates that advanced endosurgical techniques in infants are safe, effective, and associated with the same minimal morbidity and decreased hospital stays as in older patients.