Laparoscopic and Computer-Assisted Surgery in Children

Abstract

Today, pediatric laparoscopy is mostly performed using 2 mm, 3 mm and 3,5 mm instruments which have been developed in the 1990’s to work with greater ease in the confined spaces of the pediatric abdominal cavity compared to the 5 or 10 mm instruments designed for adult patients. Most surgeons prefer to introduce a blunt subumbilical camera trocar in an open “Hasson’s” technique to avoid injury of abdominal organs or blood vessles which has been described for the blind puncture with the “Veress” needle. after tying the subumbilical fascial purstring suture, the CO2pneumoperitoneum is established under visual control with a maximum flow of 5 l/min and a maximum pressure of 8–10 mmHg. Working ports are then introduced under visual control according to the procedure performed. For small children, it has been shown to be helpful to use the fascial fixation of sleeved trocars to prevent trocar dislocation and to allow intraoperative length adjustment of the intraperitoneal part of the trocar (7). To prevent CO2overinsufflation, neonatal insufflators are used, delivering CO2 in small controlled puffs, allowing a better adjustment of the intraabdominal pressure. a close interaction with experienced pediatric anaesthesists is essential to perform laparoscopic surgery in particular in small infants in a way that is most safe for the neonatal patient (8).