Removal of pediatric stage IV neuroblastoma by robot-assisted laparoscopy: A case report and literature review

Abstract

BACKGROUND Neuroblastoma (NB) is the most common extracranial solid tumor in children, with an incidence of approximately 1/10000. Surgical resection is an effective treatment for children with NB. Robot-assisted laparoscopic surgery is a new method and is superior to conventional laparoscopic surgery, since it has been preliminarily applied in clinical practice with a significant curative effect. This paper discusses significance and feasibility of complete resection of stage IV NB using robot-assisted laparoscopic surgery, while comparing its safety and effectiveness with conventional laparoscopic surgery. CASE SUMMARY In June 2018, a girl with stage IV retroperitoneal NB, aged 3 years and 5 mo, was admitted. Her weight was 15 kg, and her height was 100 cm. Robot-assisted, five-port laparoscopic resection of NB was performed. Starting from the middle point between the navel and the anterior superior iliac spine to the left lower abdomen, the pneumoperitoneum and observation hole (10 mm) were established using the Hasson technique. Operation arm #1 was located between the left anterior axillary line, the navel, and the costal margin (8 mm); operation arm #2 was located at the intersection of the right anterior axillary line and Pfannenstiel line (8 mm); one auxiliary hole was located between arm #2 (on the Pfannenstiel line) and the observation hole (12 mm); and another auxiliary hole (5 mm) was located slightly below the left side of the xiphoid. Along the right line of Toldt and the hepatic flexure of the transverse colon, the colon was turned to the left and below with a hook electrode. Through Kocher's incision, the duodenum and the pancreatic head were turned to the left to expose the inferior vena cava and the abdominal aorta. The vein was separated along the right external iliac, and the inferior vena cava was then lifted to expose the right renal vein from the bottom to the top. The tumor was transected horizontally below the renal vein, and it was first cut into pieces and then resected. The right renal artery and the left renal vein were also exposed, and the retrohepatic inferior vena cava was isolated. The tumor was resected along the surface of the psoas muscle, the back of the inferior vena cava, and the right side of the abdominal aorta. Finally, the lymph node metas-tases in front of the abdominal aorta and left renal vein were completely removed. The specimens were loaded into a disposable specimen retrieval bag and removed from the enlarged auxiliary hole. T-tube drainage was placed and brought out through a hole in the right lower quadrant of the abdomen. The operative time was 389 min, the time of pneumoperitoneum was 360 min, the intraoperative blood loss was approximately 200 mL, and the postoperative recovery was smooth. There were no complications, such as lymphatic fistula, diarrhea, bleeding, and paralytic ileus. Two months after discharge, there were no other complications. The literature on the application of robot-assisted laparoscopic...

Paediatric robotic surgery: a narrative review

“…Despite this, there does exist a wide range of literature mostly in the form of individual case reports or small case series. One case of successful robotic resection of a stage IV neuoroblastoma has been reported, with the authors noting that the enhanced vision and precision of the robotic platform allowed for skeletalisation of tumour vasculature that may not have been feasible laparoscopically [61]. Another case described the management of a 4 cm juvenile cystic adenomyoma by a robotic approach in a 15-year-old girl, with improved ergonomics allowing for four-layered closure of the uterus, followed by an uneventful post-operative recovery [62].…”

“…A common theme discussed in many of these cases is the advantages offered by a robotic approach to extended lymph node dissection resulting from enhanced 3-dimensional vision [13,[61][62][63][64]. A recent case series of 12 robotic resections of paediatric abdominal tumours concluded that oncological surgical principles were maintained by this approach, with all achieving R0 resection status, low postoperative morbidity and good long-term results.…”

Robotic-Assisted Minimally Invasive Surgery in Children

“…Complete resection is curative in low-stage disease. Robotic surgery can skeletonize abdominal blood vessels in the tumor and cut the tumor into pieces, including stage IV retroperitoneal neuroblastoma [155,156].…”

Comparative analysis of robotic vs laparoscopic radical hysterectomy for cervical cancer

“…The latest guidelines from the National Comprehensive Cancer Network and the European Society of Gynecological Oncology suggest that open surgery and laparoscopic surgery (using traditional laparoscopic or robotic techniques) are the main surgical approaches for radical hysterectomy for patients with stage IA2-IIA cervical cancer[7-9]. Robotic surgery has been increasingly used in abdominal surgery and has shown more beneficial effects[10-12].…”