Endosurgery in Children: Prospects and Problems— An Analysis of 88 Cases

Abstract

To evaluate the clinical benefits and problems associated with pediatric endosurgery, we analyzed our own experience of laparoscopy in children. From 1992 to 1996, 88 children underwent endosurgery at our hospital. Ages ranged from 2 days to 16 years; 23 were neonates. To confirm the safety of carbon dioxide (CO₂) gas insufflation in children, especially in neonates, we monitored the end tidal CO₂ level, oxygen (O₂) saturation, blood pressure, and body temperature during endosurgery. Interleukin-6 (IL-6) and C-reactive protein (CRP) were measured serially to estimate the degree of surgical stress encountered during endosurgery and were compared with results obtained from patients who had undergone open surgery. CO₂ gas insufflation was safely carried out in most cases at a speed of 1.0 L/min to an intra-abdominal pressure of 8 to 10 mmHg. However, hypothermia due to rapid insufflation of cool CO₂ gas was encountered in 4 neonates insuffflated under these conditions. We have not encountered this complication since we started using a Thermoflator^® to warm the CO₂ gas to 37°C and set the insufflation speed at less than 0.5 L/min. IL-6 was considerably lower during endosurgery compared with open surgery.