Paediatric Anaesthesia in Laparoscopic and Robotic Surgery
Video-assisted surgery was born at the beginning of the century and more widely diffused from the 1960s, principally to respond to the need to perform surgeries applying less invasive methodologies. In the following years, thanks to increasingly technolog
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Paediatric Anaesthesia in Laparoscopic and Robotic Surgery Nicola Disma, Rachele Bonfiglio, and Giovanni Montobbio
Video-assisted surgery was born at the beginning of the century and more widely diffused from the 1960s, principally to respond to the need to perform surgeries applying less invasive methodologies. In the following years, thanks to increasingly technologically advanced equipment, there has been an expansion of clinical indications, until you get to its daily use in paediatrics, in children as infants. From the anaesthesiologist’s point of view, we have to consider that the video-assisted surgery involves a large number of physiological modifications mainly related to cardio-respiratory dynamics and due to the patient’s health status, the patient’s position on the operating room table and the insufflation of gas in the abdominal cavity. For all this reasons, it is important that the anaesthesiologist knows all the physio-pathological changes during laparoscopic surgery in order to prevent them with the careful application of vital signs monitoring, especially in children in order to deliver the best anaesthetic care and promote patient safety [1].
N. Disma (*) • R. Bonfiglio • G. Montobbio Department of Pediatric Anesthesia, Giannina Gaslini Institute, Genoa, Italy e-mail: [email protected]
6.1
Laparoscopic Surgery
6.1.1 Advantages Laparoscopic surgery is nowadays considered a safe and well-tolerated approach, widely applied to most of the paediatric surgical patients and it has many advantages if compared to “open surgery”: • Smaller surgical incisions with better cosmetic results and therefore greater patient acceptance • Reduced post-operative pain with less need for analgesic drugs • Magnified view of the surgical field that allow improved visualization of some difficult areas (pelvis, subphrenic spaces and thoracic apices) • Fewer post-operative respiratory complications • Fewer wound complications and fewer adhesions • A short period of post-operative ileus • Less fluid loss • Earlier post-operative mobilization • Quicker recovery from surgery • A short hospital stay with benefits both to the work of parents and the child’s absence from school
© Springer International Publishing Switzerland 2017 G. Mattioli, P. Petralia (eds.), Pediatric Robotic Surgery, DOI 10.1007/978-3-319-41863-6_6
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6.1.2 Disadvantages While the length of hospital stay decreased, other surgical time increases in inverse proportion to the experience of the surgeon performing the procedure. Laparoscopic surgery is particularly difficult in infants because of the smaller operative field: we have instruments with limited degrees of freedom, two-dimensional vision with an assistant-dependent unstable video camera platform and amplification of natural tremor [2, 3]. In addition, surgical equipment has very high costs.
6.2
Robotic Surgery
6.2.1 Advantages Robotic-assisted surgery is an evolutionary step in the advancement of minimally invasive surgical procedures. Nowadays there are two su
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