Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Abstract

Background: Pediatric robot-assisted surgery (RAS) is gaining increasing acceptance. We aimed to assess the diffusion of pediatric RAS in Italy, the training period, indications, preliminary outcomes, and limitations. Materials and Methods: An online questionnaire-based survey was performed. The data about robotic activity of 9 Italian Pediatric Surgery units were collected and analyzed. Results: Most of the participating centers (7/9, 77.8%) started RAS less than 5 years ago with only 2 centers (22.2%) performing RAS since 2010. The training included dry-lab in 5/9 centers (55.5%), wet-lab in 5/9 centers (55.5%), and robot simulator in 7/9 centers (77.8%), followed by an exam to obtain a certificate. The average duration of training was 23.7 hours (range 5-50). A total of 209 robotic procedures was performed in all centers during the period 2010-2018 and included 119 urological (56.9%), 31 gynecological (14.8%), 41 gastrointestinal (19.6%), 12 oncological (5.7%), and 6 other (2.8%) procedures. The docking time significantly fell down after 18 robotic procedures (P = .001). Intraoperative complications were recorded in 4 cases (1.9%). Conversion to laparoscopy was needed in 4 cases (1.9%) whereas conversion to open was required in 6 cases (2.8%). Postoperative complications occurred in 17/209 cases (8.1%) and were graded Clavien I-II in 14 cases (6.7%) and Clavien IIIb in only 4 cases (1.9%). Conclusions: Our study confirmed that RAS has still a limited diffusion in Italy for pediatric patients. Before starting robotic activity, pediatric surgeons have to obtain a certificate after a virtual and experimental training period. A mentorship clinical period of 10 cases under supervision of a proctor is also needed. The main indications in children remain reconstructive urological procedures. RAS is safe in children but its applications are currently limited to patients older than 2 years and with a weight >15 kg, due to the size of robotic ports.

Implementing a pediatric robotic surgery program: future perspectives

“…Our youngest patient was 7 months old. Of the children under 5 years of age who underwent surgery, The distribution of pathologies reported by other studies (24) shows higher prevalence of urological pathologies, which in our case represented 35%. Digestive/tumor pathologies are overrepresented in our study because minor abdominal procedures such as appendectomy or cholecystectomy have been used as a starting point for robotic surgery programs (25) .…”

Pediatric urology research in 2020: A bibliometric analysis of the top 100 most cited articles

“…17 To date, a recent Italian survey reported that pyeloplasty was the most frequent RALS procedure performed in the Units of Pediatric Surgery. 18 Conversely, RALS extravesical ureteral reimplantation has not already reach the same standards of success of the open surgery, showing a higher rate of complications. 19 However, RALS presented higher costs, a learning-curve for the operators, and the need of a dedicated setting and surgical team.…”

Robotic surgery in a 12-year-old girl to achieve Cholecystectomy and total Splenectomy indicated for complications of hereditary spherocytosis: Case report

“…This may be due to the current hardware equipment and the characteristics of pediatric surgical diseases. Current authors recognize that robotic surgery is safe in children with a body weight of more than 15 kilograms and aged more than 2 years [8] . Our patient was 12 years old and weighed 41 kilograms, which is still widely recognized as eligible for robotic surgery.…”