Expanding safety boundaries in pediatric robotic-assisted laparoscopic surgery: are we protecting our children?

Little is known about the effects of CO insufflation (CDI) on cerebral oxygen saturation (CrSO) during laparoscopy in the pediatric population. In children undergoing robotic-assisted laparoscopic pyeloplasty (RALP), we prospectively assessed the effects of CDI using standard monitoring and cerebral near-infrared spectroscopy (NIRS). We also explored whether a correlation existed between CrSO and parameters known to affect cerebral blood flow. Between January 2021 and September 2023, a cohort of consecutive children older than 2 years underwent RALP at Necker-Enfants Malades Hospital in Paris. A ventilation protocol aimed to prevent hypercarbia was implemented. Data collected included standard monitoring parameters and CrSO by NIRS. Thirty patients (16 females), mean age 5.5 ± 3.9 (2.0-9.5) years, were included. Twenty-three patients underwent a retroperitoneal approach. The mean baseline CrSO value was 83.0 ± 9.8. Mean CrSO decreased during progressive CDI, never below baseline values, while standard-monitoring parameters did not significantly change. No significant correlation was detected between CrSO and end tidal CO, or between CrSO and mean arterial pressure, at any operative time. During RALP, a gradual CDI doesn't cause pathological derangements of CrSO. The lack of correlation between CrSO and standard parameters affecting cerebral blood flow suggests the likely presence of cerebral autoregulation in our population.