Pediatric Robotic Surgical Program

Abstract

T he development of pediatric robotic surgery has been slower than in the adult surgical world; however, it has been applied to a very wide variety of procedures with overall successful outcomes. The clinical value and utility of pediatric robotic surgery remain incompletely defined. The report by Vinit et al 1 adds further demonstration of the safety of pediatric robotic surgery in multiple specialties and with diverse applications. The authors should be applauded for their consistent approach and for close monitoring of their surgical outcomes. It is reassuring that the current robotic system can be applied with a high degree of safety in multiple specialties, including pediatric surgery. However, some considerations should be factored into our interpretation of this study.What can we take away from this report that is applicable to pediatric surgical practice in general? With experiences in large numbers, the rate of significant surgical complications is low in the hands of an experienced surgeon. This report examines the influence of time and the learning curve on the overall surgical outcomes, as well as important patient factors, such as comorbidities and American Society of Anesthesia status. There is some variation in basic morbidity rates depending upon the specialty, which is to be expected, in particular, oncologic cases which did have a higher rate of complications. It is safe to say that this would likely be the case for open surgical approaches as well; complex patients have complex surgical scenarios. The types of complications are somewhat correlative to the types of surgery. Urological surgeries, which are predominantly reconstructive have fewer major complications, but they had a significant number of urinary tract infections. This would need to be compared with a comparable cohort of open-surgical patients to allow a useful perspective. These are relatively mild occurrences in general and readily managed as an outpatient.It is important, however, to evaluate these data and recognize that the setting is unique and may not be generally applied to United States pediatric surgical centers. In countries with centralized referral care for children, such as France, the ability to amass many complex patients in a relatively short time is distinct from similar hospitals in the United States. Referral patterns are also distinct in terms of which surgical providers care for patients with oncologic issues, particularly those of the genitourinary tract.The authors have addressed the issue of the impact of the learning curve on the incidence of surgical complications but cannot adequately factor in what could be termed the community learning curve. Many of the cases they performed had been well described in the literature and presented at surgical conferences and courses. This permits the newer surgeon to already possess the benefit of the experience of others in terms of optimal positioning, instrumentation, and the surgical steps for a given procedure. As robotic surgery emerged in pediatrics, there was no...