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

Abstract

Objective: We present the applications and experiences of robot-assisted laparoscopic and thoracoscopic surgery (RALTS) in pediatric surgery. Materials and Methods: A prospective, observational, and longitudinal study was conducted from March 2015 to March 2018 that involved a non-random sample of a pediatric population that was treated with RALTS. The parameters examined were: gender, age, weight, height, diagnoses, surgical technique, elapsed time of console surgery, estimated bleeding, need for hemotransfusion, complications, surgical conversions, postoperative hospital stay, and follow-up. The Clavien-Dindo classification of complications was used. The surgical system used was the da Vinci model, Si version (Intuitive Surgical, Inc., Sunnyvale, CA. U.S.A), with measures of central tendency. Results: In a 36-months period, 186 RALTS cases were performed, in 147 pediatric patients and an adult; 53.23% were male, and the remaining were female. The average age was 83 months, ranging from 3.5 to 204 months, plus one adult patient of 63 years. The stature was an average of 116.6 cm, with a range of 55–185 cm; the average weight was 26.9 kg, with a range of 5–102 kg; the smallest patient at 3.5 months was 55 cm in stature and weighed 5.5 kg. We performed 41 different surgical techniques, grouped in 4 areas: urological 91, gastrointestinal and hepatobiliary (GI-HB) 84, thoracic 6, and oncological 5. The console surgery time was 137.2 min on average, ranging from 10 to 780 min. Surgeon 1 performed 154 operations (82.8%), and the remainder were performed by Surgeon 2, with a conversion rate of 3.76%. The most commonly performed surgeries were: pyeloplasty, fundoplication, diaphragmatic plication, and removal of benign tumors, by area. Hemotransfusion was performed for 4.83%, and complications occurred in 2.68%. The average postoperative stay was 2.58 days, and the average follow-up was 23.5 months. The results of the 4 areas were analyzed in detail. Conclusion: RALTS is safe and effective in children. An enormous variety of surgeries can be safely performed, including complex hepatobiliary, and thoracic surgery in small children. There are few published prospective series describing RALTS in the pediatric population, and most only describe urological surgery. It is important to offer children the advantages and safety of minimal invasion with robotic assistance; however, this procedure has only been slowly accepted and utilized for children. It is possible to implement a robust program of pediatric robotic surgery where multiple procedures are performed.

Thoracic surgery by minimally invasion robot-assisted in children: “experience and current status”

“…Acquired anomalies, such as diaphragmatic paralysis, can also be resolved with RATS. The experience of other authors and ours confirms that robotic surgery is safe and effective for repairing diaphragm abnormalities in children [23,45] . Slater and Meehan [45] preferred the thoracic approach for repairing Bochdalek congenital diaphragmatic hernia, but sometimes smaller babies, less than 2.5 kg, can improve with the abdominal approach, since articulated instruments require considerable length to maneuver.…”

“…However, many studies have reported that robotassisted surgery is safe and feasible for pediatric patients. RATS has previously been described as part of a series of general pediatric surgeries or a series of various thoracic pathologies [22,23,26,27] , a series of pediatric cases of specific procedures such as thymectomy for myasthenia gravis [28,29] , tracheopexy for treatment of severe tracheomalacia [30] , or as pediatric case reports on esophageal leiomyoma and bronchogenic cyst [31][32][33] .…”

“…Seven cases are part of the statistics of our published series of the first three years of robotic surgery [23] .…”

“…The docking charts for robotic surgery suggested for surgical techniques in adults are not applicable for children. Therefore, sometimes, 3 cm of separation was required between each trocar when surgery was performed on infants, due to limited space in such small patients [23] .…”

Should Robotic Surgery Simulation Be Introduced in the Core Surgical Training Curriculum?

“…While robotics is widely applied in different fields, the medical use of this equipment has been on the rise. According to Arellano and González ( 1 ), robotics is used in urology and other medical disciplines ( 2 ). However, robotic training and simulation still trail to adopt this form of surgical technology.…”