Gasless laparoscopy in infants: the rabbit model

Abstract

Laparoscopic operations can be performed in neonates and infants, but carbon dioxide pneumoperitoneum may be more dangerous than in adults. Therefore the concept of gasless laparoscopy is especially attractive for small children. The authors have developed an animal training model of gasless infant laparoscopy using the rabbit. Eleven New Zealand white rabbits (mean weight, 2.2 kg) were premedicated with fentanyl (10 micrograms intramuscularly) and maintained under inhalation anesthesia by mask, with halothane (1.0 to 2.5%) in oxygen and nitrous oxide (1:1). The animals were neither intubated nor mechanically ventilated. Heart rate and oxygen saturation were monitored by pulse oximetry. A supraumbilical incision was made through the peritoneum, and an abdominal wall elevator was inserted. A 4-mm-diameter 30 degrees endoscope was introduced at the same site, allowing excellent visualization of the abdominal cavity. Three additional 5-mm cannulas were placed, and a standard Nissen fundoplication was performed in all 11 animals. In seven of these, a left nephrectomy was also performed. Five-millimeter pediatric instruments and 1.7- and 2.7-mm laryngoscopic instruments were used. The rabbit can serve as a training model for laparoscopy in the infant. Gasless laparoscopy, using abdominal wall elevation, may be particularly useful in very small patients.