Advanced minimal access surgery in infants weighing less than 3kg: A single center experience

J Pediatr Surg. 2018 Mar;53(3):503-507. doi: 10.1016/j.jpedsurg.2017.05.006. Epub 2017 May 11.


Background: Minimal access surgery (MAS) has gained popularity in infants less than 5kg, however, significant challenges still arise in very low weight infants.

Study design: A retrospective chart review was performed to identify all infants weighing less than 3kg who underwent an advanced MAS or equivalent open procedure from 2009 to 2016. Advanced case types included Nissen fundoplication, duodenal atresia repair, Ladd procedure, congenital diaphragmatic hernia repair, esophageal atresia/tracheoesophageal fistula repair, diaphragmatic plication, and pyloric atresia repair. A comparative analysis was performed between the MAS and open cohorts.

Results: A total of 45 advanced MAS cases and 17 open cases met the inclusion criteria. Gestational age and age at operation were similar between the cohorts, while infants who underwent open procedures had significantly lower weight at operation (p=0.003). There were no deaths within 30days related to surgery in either group. Only 3 MAS cases required unintended conversion to open. There were 2 (4.4%) postoperative complications related to surgery in the MAS cohort and 2 (11.8%) in the open cohort.

Conclusion: Advanced MAS may be performed in infants weighing less than 3kg with low mortality, acceptable rates of conversion, and similar rates of complications as open procedures.

Type of study: Prognosis study.

Level of evidence: Level III.

Keywords: Laparoscopy; Minimal access surgery; Neonatal surgery; Thoracoscopy.

Publication types

  • Comparative Study

MeSH terms

  • Birth Weight*
  • Diaphragm / surgery
  • Esophageal Atresia / surgery
  • Fundoplication / adverse effects
  • Gestational Age
  • Hernias, Diaphragmatic, Congenital / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Intestinal Atresia / surgery
  • Minimally Invasive Surgical Procedures* / adverse effects
  • Postoperative Complications
  • Pylorus / abnormalities
  • Pylorus / surgery
  • Retrospective Studies
  • Tracheoesophageal Fistula / surgery

Supplementary concepts

  • Esophageal atresia with or without tracheoesophageal fistula