Multicentric assessment of the safety of neonatal videosurgery.
BACKGROUND
Complex procedures for managing congenital abnormalities are reported to be feasible. However, neonatal videosurgery involves very specific physiologic constraints. This study evaluated the safety and complication rate of videosurgery during the first month of life and sought to determine both the risk factors of perioperative complications and the most recent trends in practice.


METHODS
From 1993 to 2005, 218 neonates (mean age, 16 days; weight, 3,386 g) from seven European university hospitals were enrolled in a retrospective study. The surgical indications for laparoscopy (n = 204) and thoracoscopy (n = 14) were congenital abnormalities or exploratory procedures.


RESULTS
Of the 16 surgical incidents that occurred (7.5%), mainly before 2001, 11 were minor (parietal hematoma, eventration). Three neonates had repeat surgery for incomplete treatment of pyloric stenosis. In two cases, the incidents were more threatening (duodenal wound, diaphragmatic artery injury), but without further consequences. No mortality is reported. The 26 anesthetic incidents (12%) that occurred during insufflation included desaturation (<80% despite 100% oxygen ventilation) (n = 8), transient hypotension requiring vascular expansion (n = 7), hypercapnia (>45 mmHg) (n = 5), hypothermia (<34.9 degrees C) (n = 4), and metabolic acidosis (n = 2). The insufflation had to be stopped in 7% of the cases (transiently in 9 cases, definitively in 6 cases). The significant risk factors for an incident (p < 0.05) were young age of the patient, low body temperature, thoracic insufflation, high pressure and flow of insufflation, and length of surgery.


CONCLUSIONS
Despite advances in miniaturizing of instruments and growth in surgeons' experience, the morbidity of neonatal videosurgery is not negligible. A profile of the patient at risk for an insufflation-related incident emerged from this study and may help in the selection of neonates who will benefit most from these techniques in conditions of maximal safety.
Kalfa
Nicolas
N
Service de Chirurgie Viscérale Pédiatrique, Hôpital Lapeyronie, 275 Av Doyen Gaston Giraud, 34295, Montpellier, France.
Allal
Hossein
H
Raux
Olivier
O
Lardy
Hubert
H
Varlet
Francois
F
Reinberg
Olivier
O
Podevin
Guillaume
G
Héloury
Yves
Y
Becmeur
Francois
F
Talon
Isabelle
I
Harper
Luke
L
Vergnes
Pierre
P
Forgues
Dominique
D
Lopez
Manuel
M
Guibal
Marie-Pierre
MP
Galifer
Rene-Benoit
RB
D000367:Age Factors; D016009:Chi-Square Distribution; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000379:methods*