• Jehuda Soleman, Christian A Schneider, Viktoria A Pfeifle, Peter Zimmermann, and Raphael Guzman.
• Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland. Electronic address: jehuda.soleman@gmail.com.
• World Neurosurg. 2017 Mar 1; 99: 656-661.

ObjectivesTo analyze the safety and feasibility of laparoscopic-assisted ventriculoperitoneal shunt (VPS) insertion in children younger than the age of 1 year and weighing less than 5 kg.MethodsWe performed a retrospective review of children receiving laparoscopic-assisted VPS. Patient characteristics, complications, operation and hospitalization time, blood loss, and conversion to the standard approach were noted and analyzed.ResultsLaparoscopic-assisted VPS was performed in 25 children. Mean age was 32 months (range 19 days to 18 years); 16 patients (64%) were younger than the age of 1 year and 10 patients (38%) weighed less than 5 kg at the time of surgery. In all cases laparoscopic insertion was possible without the need to convert to the standard approach. No intraoperative laparoscopy-associated complications occurred. Mean estimated blood volume lost was 4.52%, showing no significant difference between patients younger and older than 1 year. Mean operation time was 75.44 minutes (range 45-121 minutes), and mean hospitalization time was 37.1 days (range 4-142 days, median: 22 days). Patients younger than the age of 1 year showed significant shorter operation time (P < 0.001) and longer hospitalization time (P = 0.04). Complication rate within 30 days was 24% (n = 6), and overall complication rate was 36% (n = 9), whereas none were related to the abdominal placement of the catheter, and showed no difference between the 2 age groups.ConclusionsLaparoscopic-assisted VPS insertion in children seems to be safe and feasible leading to very good results even in patients under the age of 1 and weighing less than 5 kg.Copyright © 2016 Elsevier Inc. All rights reserved.

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