Neonatal Laparoscopic Surgery refers to the use of minimally invasive techniques in newborns using small incisions, a camera (laparoscope), and specialized instruments. It is increasingly used in well-selected neonatal cases due to its advantages in reducing surgical trauma, improving recovery, and providing better cosmetic outcomes.
Advantages of Laparoscopic Surgery in Neonates
- Smaller incisions and less postoperative pain
- Reduced risk of wound infection and hernia
- Shorter hospital stay and faster recovery
- Better visualization of the operative field
- Improved cosmetic results
Challenges in Neonatal Laparoscopy
- Limited working space due to small abdominal cavity
- Physiological effects of CO2 insufflation (hypothermia, acidosis, respiratory compromise)
- Requires advanced surgical skill and neonatal anesthesia expertise
- Specialized instruments (typically 3 mm or 5 mm) are needed
Common Indications for Neonatal Laparoscopic Surgery
- Diagnostic laparoscopy for non-palpable testes
- Pyloromyotomy for hypertrophic pyloric stenosis
- Ladd’s procedure for malrotation
- Repair of congenital diaphragmatic hernia (CDH)
- Exploration of abdominal masses or duplication cysts
- Assisted minimally invasive procedures (e.g., appendectomy in older neonates)
Instrumentation and Equipment
- 3 mm or 5 mm laparoscopic ports
- High-definition laparoscopic camera system
- CO2 insufflator with pressure and flow regulation for neonates
- Thermal regulation equipment (to prevent hypothermia)
Perioperative Considerations
- Close monitoring of temperature, ventilation, and perfusion
- Minimized insufflation pressures (4–8 mmHg)
- Postoperative pain management and early feeding protocols
Outcomes and Safety
- Comparable or superior outcomes to open surgery in selected cases
- Requires specialized centers with neonatal surgery expertise
- Short-term and long-term results depend on surgeon experience and case selection
Conclusion
Neonatal laparoscopic surgery is a safe and effective option for various congenital and acquired conditions. With advances in instrumentation and growing expertise, it is becoming more widely adopted in neonatal surgical care, offering significant benefits when performed by skilled teams in well-equipped centers.
