# Technique modifications: enabling laparoscopic repair of duodenal atresia in a preterm, very low birthweight infant

## TL;DR

This paper describes a modified laparoscopic technique for repairing duodenal atresia in a very low birthweight infant.

## Contribution

The novel contribution is a modified port placement and instrument positioning strategy for laparoscopic surgery in preterm infants.

## Key findings

- Modifying port placements allowed for better laparoscopic access in a 1.3 kg preterm infant.
- The described technique maximizes working space and may reduce complications in such surgeries.

## Abstract

Laparoscopic procedures, which are already challenging in infants and small children, are made even more challenging in very low birthweight infants due to the limited working space within the abdomen and the decreased tolerance for high insufflation pressures. Here we describe how modifying port placements and instrument positioning allowed for the laparoscopic repair of duodenal atresia in a preterm 1.3 kg infant. In our modified approach: (i) the umbilical-port was our right-hand working port, (ii) the right lower quadrant port was used for the telescope, (iii) the left central abdomen port was used as an optional assistant port, and (iv) the right upper quadrant port, was modified to be in the right lateral upper abdomen and used as the left hand working port. We believe these modifications could help pediatric surgeons maximize laparoscopic working space and therefore, prevent complications and improve patient outcomes for the procedure.