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Laparoscopic Toupet Fundoplication using an Air Seal Intelligent Flow System and Anchor Port in a 1.8‐kg infant: A Technical Report
Author(s) -
Miyano Go,
Morita Keiichi,
Kaneshiro Masakatsu,
Miyake Hiromu,
Nouso Hiroshi,
Yamoto Masaya,
Koyama Mariko,
Nakano Reiji,
Tanaka Yasuhiko,
Fukumoto Koji,
Urushihara Naoto
Publication year - 2015
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12182
Subject(s) - medicine , pneumoperitoneum , surgery , cannula , esophagus , insufflation , reflux , nissen fundoplication , port (circuit theory) , abdomen , leak , laparoscopy , disease , pathology , environmental engineering , electrical engineering , engineering
We report a case of a 1.8‐kg infant who had laparoscopic T oupet fundoplication ( LTF ) using the A ir S eal I ntelligent F low S ystem and A nchor P ort ( AP ). Materials and Surgical Technique Our case had severe gastroesophageal reflux in association with genetic and cardiac anomalies. Despite the patient being continuously fed, persistent vomiting caused failure to thrive, and LTF was performed at 4 months of age when he weighed 1.8 kg. The A ir S eal I ntelligent F low S ystem is a novel laparoscopic CO 2 insufflation system that improves the visual field by constantly evacuating smoke and providing a more stable pneumoperitoneum. The AP is a recently developed, stretchable, elastomeric, low‐profile cannula. Three 5‐mm AP were inserted: one subumbilically for the scope and one in both the right and left upper abdomen for the surgeon. A 5‐mm A ir S eal trocar was inserted in the left lower abdomen for the assistant. The gastrosplenic ligament was dissected free, and the intra‐abdominal esophagus was prepared. A posterior hiatoplasty was performed, followed by the 270° fundoplication. During the fundoplication, the esophagus was fixed to the crus and then the right and left wraps were fixed to the esophagus. Pneumoperitoneum was maintained stably throughout the LTF procedure, with optimal operative field. Total operating time for LTF was 90 min. Body temperature dropped from 37.4°C to 35.7°C during pneumoperitoneum but resolved once pneumoperitoneum was ceased. Postoperative progress was uneventful, and an upper gastrointestinal study on postoperative day 2 showed no residual gastroesophageal reflux. Discussion We believe the A ir S eal I ntelligent F low S ystem and AP contributed to the successful completion of LTF in a 1.8‐kg infant.