Robotic approach for pediatric pulmonary resection: preliminary investigation and comparative study with thoracoscopic approach

Abstract

Background: Minimal invasive pulmonary resection in children is challenging, irrespective of whether it is conducted using a robot or a thoracoscope. This study presents the preliminary results of pediatric robotic pulmonary resection (RPR) and comparison outcomes with conventional thoracoscopic pulmonary resection (TPR).Methods: This is a retrospective study conducted in patients underwent RPR (RPR group; n=30) and TPR (TPR group; n=44). The clinical data, including operative time, post-operative body temperature, surgical complications, surgeon's workload (by NASA-TLX), postoperative hospital stay, and scar score (using the SCAR scale), of both the RPR and TPR groups were collected and compared.Results: Both groups had similar age and weight. The youngest patient belonged to the RPR group and was 6 months old and weighed 8 kg. One case in the RPR group and two in the TPR group were converted to thoracotomy. RPR had a longer total operative time (148.3±36.8 min), but a shorter pure operative time (103.9±28.5 min) than those of the TPR group [118.3±22.5 (P<0.001) and 111.4±18.3 min (P=0.045), respectively]. Compared to the TPR group, fewer patients in the RPR group reported fever postoperatively (2/29 vs. 11/42, P=0.039). The workload of the surgeons was also lower in the RPR group (55.2±4.7 vs. 62.9±6.0, P<0.01). No significant difference was observed in perioperative complications, drainage length, postoperative hospital stays, and scar score of the two groups. Conclusions:The safety and effectiveness of the robotic approach are similar to those of the thoracoscopic surgery for pediatric pulmonary resection in children heavier than 8 kg. In addition, the robotic approach shows improved operative dissection efficiency and accuracy for patients and reduced workload for surgeons.Hence, it is beneficial to both surgeons and patients.

Examining the Potential of Advanced Robotic-Assisted Thoracic Surgery in Pediatric Cases

“…They found no difference in perioperative complications, hospital stays, or drainage lengths between the two techniques. However, they noted that while the total operative time was longer, the pure operative time was shorter in RAS (18).…”

“…Li et al (18) compared the surgical outcomes of thoracoscopic and robotic-assisted pulmonary resection in the pediatric population. They found no difference in perioperative complications, hospital stays, or drainage lengths between the two techniques.…”

A tale of two techniques—thoracoscopic and robotic surgery for congenital lung lesions

“…We read with great interest the retrospective study by Li et al describing their single center experience with pediatric robotic pulmonary resection (RPR) for congenital pulmonary airway malformation (CPAM) and intralobar pulmonary sequestration (IPS) ( 1 ). In this study, the authors compare outcomes of consecutive patients undergoing minimally invasive pulmonary resection via RPR (n=29) or thoracoscopic pulmonary resection (TPR; n=42) over a 4-year period by a single pediatric surgeon and assistant.…”

“…We believe the current evidence supports the limited use of pulmonary segmentectomy for congenital lung lesions, such as in the case of multilobar or bilateral disease. Regarding post-operative care in the study by Li et al ( 1 ), the chest tube remained in place for a mean duration of nearly 2 days and the patients remained in the hospital for a mean of 3–4 days. In our experience, most patients can have their chest tube removed within 24–48 hours and be discharged within a few hours of removal.…”