Pediatric Robotic Surgery: Lessons from a Clinical Experience

Klein, Michael D.; Langenburg, Scott E.; Kabeer, Mustafa H.; Lorincz, Attila; Knight, Colin G.

doi:10.1089/lap.2006.0034

Cited by 49 publications

(32 citation statements)

References 18 publications

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“…[29] Few robotic myotomies in pediatric patients have been published in the literature (Table 3). [5][6][7][8][9][10][11] The total number of robotic Heller's myotomy cases, including ours, is 18 cases. Most patients underwent a concomitant anti-reflux procedure.…”

Section: Discussionmentioning

confidence: 79%

“…[3] Another advantage of a robotic procedure is telesurgery, which can potentially be used in situations or environments in which it is difficult to transport a patient or a surgeon. [8] In a large retrospective comparative study including 2683 adult patients who underwent open, laparoscopic or robotic Heller's myotomy, Shaligram et al found no differences between the laparoscopic and robotic procedures in terms of morbidity, mortality, length of hospital stay or readmission rate. Both laparoscopic and robotic surgeries were superior to open myotomy regarding perioperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Few case reports have been published on robotic-assisted Heller's myotomy in children. [5][6][7][8][9][10][11] The aim of this report is to describe our experience with robotic-assisted Heller's myotomy in children and to review the literature.…”

Section: Introductionmentioning

confidence: 99%

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Robot-assisted Heller’s myotomy for achalasia in children

Altokhais

Mandora

Alqahtani

et al. 2016

Computer Assisted Surgery

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Background: Achalasia is rare in children. Surgical options include open, laparoscopic and robotic approaches. However, Heller's myotomy remains the treatment of choice. This report describes our experience with robot-assisted Heller's myotomy in children and presents a review of the literature. Methods: Included in this study are children who underwent robot-assisted Heller's myotomy for esophageal achalasia via the Da Vinci surgical system between 2004 and 2015 at King Saud University Medical City, Riyadh, Saudi Arabia. The medical records of these patients were reviewed for demographic data, presenting symptoms, diagnostic modalities, operative procedures, complications, outcomes and follow-ups. Results: Six patients were identified. The age of the patients at surgery ranged between 2 and 12 years (mean 7.1 years). The most common presenting symptoms were dysphagia, vomiting and nocturnal cough. Contrast swallow and upper gastrointestinal endoscopy established a diagnosis of esophageal achalasia in all of the patients. Four patients underwent esophageal dilatation 2-5 times before the definitive procedure. All patients underwent successful robot-assisted Heller's myotomy with concomitant partial posterior fundoplication. The postoperative course was uneventful. Five patients had a complete resolution of the symptoms and one patient improved. The follow-up assessments have been consistent and have ranged from 0.5 to 11 years (mean 4.4 years). Conclusion: Robotic-assisted Heller's myotomy for esophageal achalasia in children is safe and effective and is a suitable alternative to open and laparoscopic approaches.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Robot-assisted Heller’s myotomy for achalasia in children

Altokhais

Mandora

Alqahtani

et al. 2016

Computer Assisted Surgery

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“…It can increase dexterity of minimally invasive surgeon, but procedures require more time, and at the present there are no defined patient benefits. However, it creates exciting possibilities for surgeons' training, planning operations and performing surgery at great distances from the operator 14 . What is not acceptable is the frequent learning surgical practice, especially in public hospitals, of using poor human being patients as guinea-pigs for surgeons' training.…”

Section: Background and Commentsmentioning

confidence: 99%

Evidence and experience: what is the balance in surgeons' training?

Brandt¹

2007

Acta Cir. Bras.

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Surgeons' training requires professionalism, continuing medical education, and appropriate environment to ensure the desirable success. However, generally, this goal is pursued in an inefficient way, based upon intensive training skills founded in the age-old philosophy of "the way I have learned it". There is, usually, a lack of patient outcome evaluation, especially of long-term follow-up of surgical procedures, which in turns provide little evidence of senior surgeons for adequate training junior surgeons. On the other hand, questioning the established knowledge is not stimulated, or even not tolerated by the seniors. It seems like the "truth" is absolute and allows no change for the new knowledge, which would mean no additional progress. There is a need to significantly alter the implementation of new knowledge, if possible based on evidence, to ensure the best medical care for the surgical patient. Experimental surgery, and nowadays bench model surgery, may be useful in minimizing the predictable complications of patients under the surgeon training responsibility, while on learning curve. Surgery based on evidence should be one of the tools for improving patient surgical care, since this important branch of medical activity must rest on two pillars "art and science"; and surgeon in good training needs to be close to both. Key words: Evidence Based Medicine. Problem-Based Learning. Education. RESUMOO treinamento dos cirurgiões requer profissionalismo, educação médica continuada e ambiente apropriado para assegurar o sucesso desejado. Contudo, geralmente, este objetivo perseguido, de forma ineficiente, é baseado em treinamento de habilidades que tem como fundamento uma filosofia clássica, não moderna -, "da forma como eu aprendi". Existe, usualmente, falta de seguimento, em longo prazo, dos pacientes submetidos a procedimentos cirúrgicos, oferecendo pouca evidência, aos cirurgiões experientes, bases fundamentadas para o treinamento adequado dos cirurgiões em treinamento. Por outro lado, o questionamento do conhecimento estabelecido não é estimulado, por vezes nem mesmo tolerado pelos cirurgiões experientes. Parece que a verdade é absoluta e não permite mudança para o novo conhecimento, o que poderia significar ausência de progresso adicional. Existe a necessidade de alterar significativamente a implementação do novo conhecimento, se possível baseado em evidência, no sentido de assegurar o melhor cuidado médico para o paciente cirúrgico. A cirurgia experimental, e atualmente, os modelos cirúrgicos de bancada, podem ser úteis, no sentido de minimizar as complicações previsíveis nos pacientes sob responsabilidade dos cirurgiões em treinamento, enquanto na curva de aprendizado. Cirurgia baseada em evidência deve ser uma das ferramentas para melhorar o atendimento ao paciente cirúrgico, desde que esse ramo importante da atividade médica deve se fundamentar em dois pilares -, "arte e ciência"; e o cirurgião em bom treinamento necessita estar próximo de ambos. Descritores: Medicina Baseada em Evidências. Apr...

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“…The first reports on the use of surgical robots for abdominal surgery in children were published by Gutt et al and Heller et al in 2002 [3,4]. Since then, a number of reports have been published describing case experiences with a variety of or certain procedures [5][6][7][8][9][10][11][12][13][14][15]. Here, I present my experience with robot-assisted surgery in infants and children and examine its feasibility, safety, advantages, and limitations.…”

Section: Introductionmentioning

confidence: 99%

Robotic-assisted surgery in children: advantages and limitations

Albassam

2010

J Robotic Surg

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The use of surgical robots in minimally invasive surgery was developed to overcome difficulties seen with conventional laparoscopic surgery. I report my experience with pediatric robotic-assisted surgery and highlight its feasibility, safety, advantages, and limitations. Children and infants included in this study underwent robotic-assisted laparoscopic procedures performed by the author, using the original da Vinci surgical system, between July 2005 and July 2008. Their medical records were reviewed with respect to demographic data, robot setup times, techniques and operative procedures, complications, outcomes, and follow-up duration. Forty-three patients (20 female, 23 male), ranging in age from 2.5 months to 16 years, underwent 46 robotic-assisted procedures. Mean setup time was 17.6 min. One primary and two to four working ports were used, allowing insertion of 5- and 8-mm robotic instruments. Five- and 11-mm telescopes were used based on patient size. All procedures were successfully completed except for two. The most common procedure was Nissen fundoplication (N = 26). There were no intraoperative complications or deaths, but three patients developed postoperative complications. Mean follow-up time was 12 months. Robotic-assisted surgery in children is safe, feasible, and applicable to a wide range of procedures. Advantages include improved visibility, dexterity, and ergonomics, although it does have certain limitations. Technological refinements will allow its use in more complex procedures, with probable greater use of robots in pediatric surgery.

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Pediatric Robotic Surgery: Lessons from a Clinical Experience

Cited by 49 publications

References 18 publications

Robot-assisted Heller’s myotomy for achalasia in children

Robot-assisted Heller’s myotomy for achalasia in children

Evidence and experience: what is the balance in surgeons' training?

Robotic-assisted surgery in children: advantages and limitations

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