Retroperitoneoscopic Surgery in Children Does Not Cause Pathological Desaturation in Cerebral/Renal Oxygenation on Near-Infrared Spectroscopy Compared with Laparoscopic and Thoracoscopic Surgery.

Introduction: Cerebral and renal regional oxygen saturation (C-rSO 2 and R-rSO 2 , respectively) were monitored using near-infrared spectroscopy in pediatric patients (range: 0.3-14.3 years) during minimally invasive surgery (MIS) taking at least 3 hours performed by laparoscopy (Lap), thoracoscopy (Tho), or retroperitoneoscopy (Ret) from January 2019 to December 2021. Materials and Methods: Criteria compared were operative time, preoperative/intraoperative hemoglobin, blood loss, mean arterial pressure, arterial partial pressure of carbon dioxide (PaCO 2 ), peripheral oxygen saturation (SpO 2 ), C-rSO 2 , and R-rSO 2 . Pathological desaturation (PD) was defined as >20% decrease from baseline, and statistical significance as P  < .05. Results: Subjects ( n  = 79) were similar for gender, age, and body mass index. MIS procedures were: Lap = 45, Tho = 20, Ret = 14; one Lap case required conversion for severe adhesions, not PD. Intraoperative PaCO 2 (mmHg) was significantly higher in Tho (maximum: 59.5 ± 17.0, minimum: 39.9 ± 7.5) versus Lap (maximum: 39.9 ± 5.1, minimum: 34.6 ± 3.9) and Ret (maximum: 37.8 ± 4.2, minimum: 35.0 ± 3.3); P  < .0001 (maximum), P  = .0013 (minimum). Minimum intraoperative SpO 2 was significantly lower in Tho ( P  < .0001). Mean operative times were significantly shorter in Tho (259 ± 114 minutes) versus Lap (433 ± 154 minutes) and Ret (342 ± 100 minutes); P  < .0001, respectively. PD was absent during Ret (C-rSO 2 : 0/14 = 0% and R-rSO 2 : 0/14 = 0%). Differences in PD for Lap (C-rSO 2 : 7/45 = 15.6% and R-rSO 2 : 10/45 = 22.2%) and Tho (C-rSO 2 : 9/20 = 45.0%, and R-rSO 2 : 7/20 = 35.0%) were significant; P  = .0028 for C-rSO 2 and P  = .0497 for R-rSO 2 . Hemoglobin and blood loss were similar. Conclusions: PD was absent during Ret, despite longer operative times. If Ret is indicated for a procedure, neurodevelopmental sequelae of MIS could be minimized.