Laparoscopic Surgery in Pediatrics
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Purpose of Review
The motivation of this review is to deepen our understanding of the physiological changes that occur during laparoscopic surgery in pediatric patients in order to detect possible complications in time to intervene and to provide the most appropriate monitoring.
Laparoscopic surgery has evolved rapidly in recent years and is considered a standard procedure in pediatric surgery. This surgical technique includes the use of pneumoperitoneum which, when combined with extreme positions (e.g., steep Trendelenburg) leads to hemodynamic, respiratory, and neuroendocrine changes, among others, which are more evident in neonates, infants, and severely ill children. During laparoscopic procedures in children, adaptive changes are observed. There are studies that focus on the relationship between laparoscopic surgery and regional oxygen saturation (rSO2). Cerebral oximetry with near-infrared spectroscopy (NIRS) could be useful for detecting cerebral oxygenation changes in time.
During laparoscopic surgery, substantive physiological changes occur. The pediatric population, especially neonates, is more sensitive to these changes than adults and may suffer sequelae as a result. Thus, we recommend further research to understand the usefulness of the specific intraoperative monitoring to prevent these sequelae.
KeywordsAnesthesia Laparoscopy Children Infants Neonates Hemodynamic changes Carbon dioxide rSo2 NIRS Pneumoperitoneum Complications
The authors thank Garrahan Hospital, its authorities, and the anesthesia service for permitting the development of this article. They also thank the surgery service and department of statistics for their contribution to this review.
Compliance With Ethical Standards
Conflict of Interest
André L. Jaichenco, Enzo L. Crivelli, Gonzalo G. Castellani, Valeria J. Damiani, Maria L. Sanchez, Carlina Victorica, and Noeli Tinti declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.• Pelizzo G, Carlini V, Iacob G, Pasqua N, Maggio G, Brunero M, et al. Pediatric laparoscopy and adaptive oxygenation and hemodynamic changes. Pediatric Reports. 2017;9:21–5. https://doi.org/10.4081/pr.2017.7214 Performs measurements of variables in different surgical times, both before and after the pneumoperitoneum. It also highlights the utility of the NIRS and the changes in the rSco 2 . CrossRefGoogle Scholar
- 3.•• Robba C, Cardim D, Donnelly J, Bertuccio A, Bacigaluppi S, Bragazzi N, et al. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods. Br J Anaesth. 2016;117(6):783–91. https://doi.org/10.1093/bja/aew356 It evidences the increase in ICP during laparoscopic surgery, added to the position of Trendelemburg.CrossRefPubMedGoogle Scholar
- 5.• Pelizzo G, Bernardi L, Carlini V, Pasqua N, Mencherini S, Maggio G, et al. Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair. J Minim Access Surg. 2017;13(1):51–6. https://doi.org/10.4103/0972-9941.181800 It highlights the relationship between the pneumoperitoneum and the cerebral oxygen saturation, measured with NIRS.CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Grag J, Kale S, Sabharwae N, Bagga D, Rajgorgia A. Hemodynamic, airway pressure and capnometrics changes and perioperative outcome in pediatric laparoscopic inguinal herniorrhaphy: a comparison with open inguinal herniorrhaphy. Anesth Essays Res. 2018;12(1):165–9. https://doi.org/10.4103/aer.AER_112_17.CrossRefGoogle Scholar
- 12.• Chu DI, Tan JM, Mattei P, Costarino AT, Rossano JW, Tasian GE. Mortality and morbidity after laparoscopic surgery in children with and without congenital heart disease. J Pediatr. 2017;185:88–93. https://doi.org/10.1016/j.jpeds.2017.02.01.1 Even in patients without congenital heart disease, impaired mobility of the ventricular wall occurs.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Kuratani N. Anesthetic management of laparoscopic surgery for infants and children. JJSCA. 2008;28(4):573–577. https://doi.org/10.2199/jjsca.28.573.
- 14.•• Hansen TG, Henneberg SW, Lerman J. General abdominal and urologic surgery. In: Cotê CJ, Lerman J, Anderson BJ, editors. A practice of anesthesia for infants and children, sixth edition. Philadelphia: Elsevier; 2018. It is the main reference book in pediatric anesthesiology, which has the latest updates.Google Scholar
- 22.• Chou CM, Yeh CM, Huang SY, Chen HC. Perioperative parameter analysis of neonates and infants receiving laparoscopic surgery. J Chin Med Assoc. 2016;79:559–64. https://doi.org/10.1016/j.jcma.2016.05.005 It refers to laparoscopic surgery in the age groups that promptly interest us . CrossRefPubMedGoogle Scholar
- 25.Spinelli G, Vargas M, Gianfranco Aprea, Giuseppe Cortese, Giuseppe Servillo. Pediatric anesthesia for minimally invasive surgery in pediatric urology. Transl Pediatr 2016:5:4:214–221 doi: https://doi.org/10.21037/tp.2016.09.02.