WOFAPS 2025 8th World Congress of Pediatric Surgery

Shilpa Sharma, Harshita Mehrotra, Arindam Choudhury, Ashish Upadhyay, P K Yadav

All India Institute of Medical Sciences, New Delhi

PURPOSE: Laparoscopic and Thoracoscopic skills are acquired over time. There is a need for simulation for thoracoscopic and Laparoscopic surgery in neonates. We aimed to demonstrate simulation and establish guidelines for standard operating procedures for safe pediatric laparoscopy and thoracoscopy surgery in Rabbits

METHOD: After Ethical Clearance (319/IAEC-1/2021), rabbits were given general anaesthesia with continuous monitoring for multiple surgical procedures. The important surgical steps and ventilator parameters were recorded. The rabbits were divided into two groups (1.7<2.5 kg and >2.5 -3.5 kg) according to weight to compare the ventilation parameters.

RESULTS: 7 rabbits (4 males), aged median 2 months (2-3 months), weighing median of 2.5 (1.7-3.5) kg were operated. The ventilation parameters during anesthesia were kept as peak Inspiratory pressure(PIP); peak Inspiratory pressure(PEEP); Fraction of Inspired Oxygen (FiO2), and respiratory rate as 17-30;5;21-40;30-70. The Carbon dioxide insufflation pressure was kept at 2-5 mmHg; 4-8 mmHg for Thoracoscopy; Laparoscopy. 16 procedures were done on 7 rabbits during 8 operative sessions. These included thoracoscopic lobectomy: esophageal repairs: fundoplication: nephrectomy: bowel anastomosis in 3;4;5:2:2. For thoracoscopic procedures, in a semi-prone (side-lying) position, a 5 mm camera port was placed in the mid-thorax along the posterior axillary line, with two 3mm working ports in the anterior axillary line. The targeted lung lobe was identified and dissected using cautery and clips to secure the vessels and bronchus. For esophageal repair, an incision was made in the esophagus and then closed. For laparoscopic fundoplication, the liver was retracted, the stomach mobilized, the crus of the diaphragm approximated and a stomach wrap was created around the esophagus. All the rabbits tolerated anesthetic doses well throughout the surgeries. The rabbits were sacrificed following the experimental procedures, under institutional and ethical guidelines for the care and use of laboratory animals. There was no difference between rabbits 1.7-2.5 kg and >2.5 -3.5 kg for FiO2 and RR (p>0.05). However, there was significant difference for PIP 20+7 vs 25+8, p<0.0412.

CONCLUSION: The Rabbit model is a good model to demonstrate neonatal laparoscopic and thoracoscopic surgery. The duration of the surgery decreased as the learning curve increased.