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Additional info for Advanced Laparoscopy
The 5mm port is often used in most cases; the 10mm port may be suitable for older children whose periumbilical region can accommodate this without excessive scarring. Secondary port size would vary according to nature of procedure. For repair of inguinal hernia, the instrument may be introduced directly through a 2-3mm opening in the skin. The depth of insertion of the port should be such as allows space for the instrument to be inserted and manoeuvred while allowing for the port to be anchored to the abdominal wall.
Acta Anaesthesiol Scand, Vol. 6, (Jul 2005), pp. 778–83, ISSN 0001-5172 Mentes, O; Harlak, A; Yigit, T; Balkan, A; Balkan, M; Cosar, A; Savaser, A; Kozak, O. & Tufan, T. (2008). Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy. 10, (Nov 2008), pp. 1353-9, ISSN 0001-5172 Millard, JA; Hill, BB; Cook, PS; Fenoglio, ME. & Stahlgren, LH. (1993). Intermittent sequential pneumatic compression in prevention of venous stasis associated with pneumoperitoneum during laparoscopic cholecystectomy.
The relatively higher body surface/ mass ratio in infants means they have a delicate fluid balance which is easily stressed and put under pressure by evaporation of body fluids from exposure of abdominal contents at laparotomy. This is minimized by the laparoscopic approach and modification of laparoscopic equipment is on-going to further limit any drying effect the gas and light may exert on abdominal viscera. As mentioned above, the short trachea in children, particularly in young infants, needs careful consideration during the entire length of the procedure especially where special positioning is required.