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Background <p>Carbon dioxide insufflation is employed in minimally invasive surgery to establish adequate working space to complete procedures. There is a lack of consensus on the optimal insufflation pressures and flow rates, as well as access preferences for use in different paediatric age groups.</p> Methods <p>A global survey was conducted among 27 expert paediatric surgeons, each with minimally invasive case volumes over 500, to assess current clinical practices for laparoscopic and thoracoscopic procedures in patients aged up to 15&#xa0;years, stratified by age group.</p> Results <p>Insufflation pressure and flow rates varied significantly across surgeons and patient age groups, with the lowest values employed for neonates and infants (6–8&#xa0;mmHg, 1L/min laparoscopic; 4–6&#xa0;mmHg, 0.63&#xa0;L/min thoracoscopic) and the highest values observed for older/obese children (12–14&#xa0;mmHg, 2.25&#xa0;L/min laparoscopic, 5–8&#xa0;mmHg, 1.63&#xa0;L/min thoracoscopic). The majority of surgeons (67%) employed the open access Hasson technique, while 22% used the Veress needle. Port size preferences were correlated with patient age: 3–3.5&#xa0;mm ports were predominant in children under 6&#xa0;years, while 5&#xa0;mm was the most popular size in children aged 6&#xa0;years and over. Fascial closure was typically performed for ports 3–3.5&#xa0;mm and larger. The most commonly used tissue sealing device was LigaSure™ (93%), followed by Ultracision™ (78%), Bipolar forceps (59%), Enseal (15%), and PlasmaKinetics™ (3.7%).</p> Conclusion <p>Data from 27 expert paediatric surgeons provided detailed overview of insufflation pressure curves, flow rates, port size preferences, and access techniques across different paediatric age groups, including obese children. While expert practices offer valuable guidance, insufflation parameters should be tailored to individual patients, aiming to employ the minimum pressure necessary to achieve adequate visualisation while minimising physiological stress.</p>

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The pressures in paediatric minimally invasive surgery

  • 期刊论文

  • 发表日期：

    2025年8月18日

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  • Amulya K. Saxena,
  • Romilly K. Hayward

摘要

Background

Carbon dioxide insufflation is employed in minimally invasive surgery to establish adequate working space to complete procedures. There is a lack of consensus on the optimal insufflation pressures and flow rates, as well as access preferences for use in different paediatric age groups.

Methods

A global survey was conducted among 27 expert paediatric surgeons, each with minimally invasive case volumes over 500, to assess current clinical practices for laparoscopic and thoracoscopic procedures in patients aged up to 15 years, stratified by age group.

Results

Insufflation pressure and flow rates varied significantly across surgeons and patient age groups, with the lowest values employed for neonates and infants (6–8 mmHg, 1L/min laparoscopic; 4–6 mmHg, 0.63 L/min thoracoscopic) and the highest values observed for older/obese children (12–14 mmHg, 2.25 L/min laparoscopic, 5–8 mmHg, 1.63 L/min thoracoscopic). The majority of surgeons (67%) employed the open access Hasson technique, while 22% used the Veress needle. Port size preferences were correlated with patient age: 3–3.5 mm ports were predominant in children under 6 years, while 5 mm was the most popular size in children aged 6 years and over. Fascial closure was typically performed for ports 3–3.5 mm and larger. The most commonly used tissue sealing device was LigaSure™ (93%), followed by Ultracision™ (78%), Bipolar forceps (59%), Enseal (15%), and PlasmaKinetics™ (3.7%).

Conclusion

Data from 27 expert paediatric surgeons provided detailed overview of insufflation pressure curves, flow rates, port size preferences, and access techniques across different paediatric age groups, including obese children. While expert practices offer valuable guidance, insufflation parameters should be tailored to individual patients, aiming to employ the minimum pressure necessary to achieve adequate visualisation while minimising physiological stress.