Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital

Abstract

Summary Background In adult urologic oncology the use of robotics has become commonplace; in pediatric urology it is rare. Herein, we describe a collaboration between an adult and a pediatric urologist performing robotic surgery for children and young adults with suspicious or cancerous genitourinary (GU) lesions. Objectives To evaluate clinical and oncologic outcomes in children and young adults undergoing robotic surgery for suspicious or cancerous lesions of the GU tract; to describe our collaborative model between an adult and pediatric surgeon at a free-standing children’s hospital. Design We retrospectively reviewed all robotic cases performed at our institution from 2014 to 2016 for patients with a GU malignancy or a suspicious mass. The surgeries were performed by a pediatric urologist with robotic experience and a fellowship-trained MIS adult urologist specializing in oncology. Perioperative and oncologic outcomes were recorded. Results A total of eight robotic cases were performed: four partial nephrectomies (PN) with retroperitoneal lymph node dissection (LND) (OT 269–338 min, EBL 5–300 mL, LOS 3–6 days), one adrenalectomy with LND (6.4 cm mass; OT 172 min, EBL 5 mL, LOS 3 days), one nephrectomy with pericaval LND (9.8 cm mass; 234 min, EBL 25 mL, LOS 3 days), and two retroperitoneal LNDs (OT 572 and 508 min, EBL 250 and 100, LOS 3 and 4 days). Patient weights ranged from 14 to 79 kg (mean 53.4 kg). There were no major complications (Clavien 3–5). Pathology results for PN included papillary RCC (AJCC pT1aNx) and two cases of segmental cystic renal dysplasia with nephrogenic rests. Bilateral template RPLNDs yielded paratesticular rhabdomyosarcoma (43 nodes; COG low risk group II stage I) and mixed non-seminomatous germ cell tumor (74 nodes; COG stage III). The nephrectomy yielded an undifferentiated sarcoma, low grade; the adrenalectomy favorable-type ganglioneuroma. Discussion In pediatrics, urologic oncology cases are often managed with open surgery. Our series demonstrates the feasibility of using the robotic approach in carefully selected cases. In doing so, the patient benefits from a minimally invasive surgery, while the surgeon benefits from robotic surgical dexterity. We seamlessly advanced these new techniques through a step-wise collaboration between an adult urologist who routinely performs robotic oncology procedures and a pediatric urologist experienced in robotics for benign conditions. Conclusion In this small series, we safely and effectively adapted adult robotic techniques for genitourinary oncology cases in children and young adults.

Robot-Assisted Laparoscopic and Thoracoscopic Surgery: Prospective Series of 186 Pediatric Surgeries

“…In pediatrics, urologic oncology cases are often managed with open surgery, but is feasibility of using the robotic approach in carefully selected cases, and safely and effectively adapted adult robotic techniques for genitourinary oncology cases in children and young adults (48).…”

“…With robotic assistance there are also risks, among others, are port-site metastases and peritoneal spread, after resection due to minimal invasion of neoplasms (44, 45). The current status of robotic surgery for tumors in children is low volume usage, and globally a relatively static adoption (46–48).…”

Robotics-Assisted Pediatric Oncology Surgery—A Preliminary Single-Center Report and a Systematic Review of Published Studies

“…The role of RAS is becoming progressively more important in every field, including pediatric oncology. In the last decade, several papers have been published on the subjects, even if the sample of the cohort is often small since most of the studies are case reports (5)(6)(7)(8)(9)(10)(11)(12). The still limited spread of this technique is due to both the concerns of the use of MIS for tumors and the well-known limitations of RAS in children (13,14).…”

Robotic‐assisted laparoscopic management of renal tumors in children: Preliminary results

“…21 To date, fewer than 10 cases of robotic management of renal tumors in children have been reported in the literature. 19,22 We report the early results of RAL total and partial nephrectomy in a high-volume pediatric reference center and show its feasibility while observing oncological surgical rules and careful patient selection. Suitability for a robotic approach was determined after discussion at the multidisciplinary tumor board.…”

“…The first applications of RAL for pediatric renal tumors were reported by Cost et al, who described in 2012 transperitoneal partial nephrectomy and in 2014 a nephrectomy in an adolescent with WT . To date, fewer than 10 cases of robotic management of renal tumors in children have been reported in the literature …”