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Physiologic Considerations for Minimally Invasive Surgery in Infants and Children

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The SAGES Manual of Pediatric Minimally Invasive Surgery

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Abstract

Laparoscopy and thoracoscopy are effective and beneficial approaches for many abdominal and thoracic surgical procedures in children of all ages. Safe application of minimally invasive surgery in pediatric patients requires an understanding of the effects of carbon dioxide insufflation. Insufflation causes two major physiological consequences—increased intra-abdominal or intrathoracic pressure and CO2 absorption—which in turn produce a variety of physiologic sequelae. Cardiac index, mean arterial pressure, and aortic blood flow decrease during abdominal insufflation, and increased intra-abdominal pressure can lead to impaired pulmonary mechanics. Increased minute ventilation must be achieved during minimally invasive surgery, especially in neonates, to prevent hypercarbia and subsequent acidosis. Newborns are very sensitive to ventilation/perfusion mismatch if single-lung ventilation is employed during thoracoscopy. Reversible anuria and oliguria occur with laparoscopy, although this effect is less common after infancy. Effects on inflammatory cytokines and cellular infiltrates appear to be less significant in laparoscopic versus open operations in children. This chapter details the physiologic effects of laparoscopy and thoracoscopy on individual organ systems and discusses general preoperative and postoperative considerations for minimally invasive surgery in children.

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Author information

Authors and Affiliations

  1. Monroe Carell Jr. Children’s Hospital at Vanderbilt, 2200 Children’s Way, Doctor’s Office Tower, Suite 7100, Nashville, TN, 37232, USA

    Brian T. Craig

  2. Pediatric Surgery, Pediatrics and Biomedical Informatics,, Monroe Carell Jr. Children’s Hospital at Vanderbilt, 2200 Children’s Way, Doctor’s Office Tower, Suite 7100, Nashville, TN, 37232, USA

    Gretchen Purcell Jackson

Authors
  1. Brian T. Craig
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  2. Gretchen Purcell Jackson
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Corresponding author

Correspondence to Gretchen Purcell Jackson .

Editor information

Editors and Affiliations

  1. Division of Pediatric Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA

    Danielle S. Walsh

  2. Northeast Ohio Medical College Division of Pediatric Surgery, Akron Children’s Hospital, Akron, Ohio, USA

    Todd A. Ponsky

  3. Division of Pediatric Surgery, Akron Children’s Hospital, Akron, Ohio, USA

    Nicholas E. Bruns

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Craig, B.T., Jackson, G.P. (2017). Physiologic Considerations for Minimally Invasive Surgery in Infants and Children. In: Walsh, D., Ponsky, T., Bruns, N. (eds) The SAGES Manual of Pediatric Minimally Invasive Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-43642-5_1

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  • DOI: https://doi.org/10.1007/978-3-319-43642-5_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43640-1

  • Online ISBN: 978-3-319-43642-5

  • eBook Packages: MedicineMedicine (R0)

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