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

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.