title: Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement in Children Younger Than the Age of 1 Year.
abstract: OBJECTIVE
  To analyze the safety and feasibility of laparoscopic-assisted ventriculoperitoneal shunt (VPS) insertion in children younger than the age of 1 year and weighing less than 5 kg.
  
  
  METHODS
  We performed a retrospective review of children receiving laparoscopic-assisted VPS. Patient characteristics, complications, operation and hospitalization time, blood loss, and conversion to the standard approach were noted and analyzed.
  
  
  RESULTS
  Laparoscopic-assisted VPS was performed in 25 children. Mean age was 32 months (range 19 days to 18 years); 16 patients (64%) were younger than the age of 1 year and 10 patients (38%) weighed less than 5 kg at the time of surgery. In all cases laparoscopic insertion was possible without the need to convert to the standard approach. No intraoperative laparoscopy-associated complications occurred. Mean estimated blood volume lost was 4.52%, showing no significant difference between patients younger and older than 1 year. Mean operation time was 75.44 minutes (range 45-121 minutes), and mean hospitalization time was 37.1 days (range 4-142 days, median: 22 days). Patients younger than the age of 1 year showed significant shorter operation time (P < 0.001) and longer hospitalization time (P = 0.04). Complication rate within 30 days was 24% (n = 6), and overall complication rate was 36% (n = 9), whereas none were related to the abdominal placement of the catheter, and showed no difference between the 2 age groups.
  
  
  CONCLUSIONS
  Laparoscopic-assisted VPS insertion in children seems to be safe and feasible leading to very good results even in patients under the age of 1 and weighing less than 5 kg.
authors.affiliation: Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland. Electronic address: jehuda.soleman@gmail.com.
authors.forename: Jehuda
authors.initials: J
authors.lastname: Soleman
authors.affiliation: Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Schneider
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland.
authors.forename: Viktoria A
authors.initials: VA
authors.lastname: Pfeifle
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Zimmermann
authors.affiliation: Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Guzman
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
keywords: Hydrocephalus; Laparoscopy; Minimally invasive surgery; Pediatric; Shunt; Ventriculoperitoneal