35 ROLE OF MINIMAL-INVASIVE AND ENDOSCOPIC SURGERY IN THE SMALL INFANT: A SINGLE-CENTER EXPERIENCE OVER 20 YEARS
Mario Lima, Sara Ugolini, Marta Maistri, Giovanni Ruggeri
Department of Pediatric Surgery, Sant'Orsola Hospital, bologna, Italy

Abstract

Aim

By definition, minimal-access surgery enables to perform major procedures with less disruption of anatomy. We report our experience in small infants.

Methods

We retrospectively reviewed registers from 1996 to 2017. All infants weighing less than 5 kg or under 100 days of age undergoing endoscopic operative procedures were included. The analysis was conducted through two groups (1996-2000 and 2001-2017). For each Group1-patient we reported age, intraoperative time and complications, type of diagnosis and procedures (which have been grouped by apparatus). Group2-patients’ additional information were: weight, gestational age, comorbidities, ASA, prenatal diagnosis and length of hospital stay. Statistical analysis of groups’ data and correlations have been conducted.

Main Results

A total of 577 (Group1 = 54; Group2 = 523) procedures were performed over a period of 21 years. Group1 shown a mean age of 44.1±29.8 days and a mean operative time of 72.8±105 minutes. Group2-patients were 60,3% males and the mean weight at surgery was of 4.253±1.299 kg. In this group we recorded a 51% of prenatal diagnosis, 32.1 % of comorbidity and 5,3% of polimalformations. Mean age was about 54.8±39.2 days. The mean ASA was about 2.32±0.65. Of a total of 523 procedures, 103 were those performed endoscopically and 420 by minimal-access surgery, of which 65 were of diagnostic value. Procedures and inherent data are reported by thoracic, gastroenteric, urological and genital apparatus.

Conclusion

With the manufacturing of specialized instruments many technical issues have been overcome making “minimal-access” safe and feasible in the neonate, as confirmed by our experience. We believe that minimally-invasive techniques are improving noticeably, but a high-level of evidence is still missing in well-designed trials. Next future direction will be to compare this population with a matching one of procedures performed by traditional approach.


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