Robotic‐assisted laparoscopic management of renal tumors in children: Preliminary results

Abstract

Aim We present the preliminary results of robotic‐assisted laparoscopic (RAL) total and partial nephrectomy for renal malignant tumors in children. Methods This is a prospective study of patients operated with RAL between December 2016 and September 2018. Patients with Wilms tumors were treated according to the SIOP‐2001 protocol. Patient and tumor characteristics, type of surgery, surgical‐related morbidity, and oncologic outcomes were recorded. Results were compared with a series of patients with similar age‐ and tumor‐related characteristics operated during the same period by an open surgical approach. Results Ten children underwent RAL nephrectomy with a mean age of five years (3.2–14.1 years). Total nephrectomy was done in six cases for Wilms tumor and in one case for renal sarcoma; three cases were converted. Complete removal of tumor without rupture was achieved in all cases. Postoperative course was uneventful, and patients were discharged between days 2 and 7. Neither recurrence nor medium‐term complications occurred. Nine patients are alive with a median follow‐up of 16 months (6–27 months) and one female died from complications of central nervous system metastases one year after surgery. When compared with the open surgical approach group, median tumor volume was smaller (P = 0.005), hospital stay was shorter (P = 0.01), and operative time was similar (P = 0.20). Conclusions RAL total and partial nephrectomy procedure for renal tumor in children may be an option in carefully selected cases. Indication should be discussed at tumor boards and surgery performed while adhering strictly to oncological surgical rules.

Robotics-Assisted Pediatric Oncology Surgery—A Preliminary Single-Center Report and a Systematic Review of Published Studies

“…To date, the published paper underlines the necessity to perform a strict selection of all children undergoing RAS, in order to adhere to oncological guidelines. The application of this technique requires an in-depth knowledge of pediatric oncology and the revision of each case by an ongoing multidisciplinary team, composed of medical oncologists, radiologists, anesthesiologists, and surgeons experienced in MIS and oncologic surgery ( 16 ).…”

The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature

“…In our single case, we did not observe any robot-related complications such as adjacent organ injury, positioning-related injury, or injury due to robotic arms. Despite some promising results of RAS reported in literature, its use should be reserved to highly selected cases and, due to lack of recommendations, surgical indication should be discussed by an expert multidisciplinary team (48)(49)(50).…”

Robotic-Assisted Minimally Invasive Surgery in Children

“…Indications for RAS nephrectomy for benign diseases are multicystic dysplastic kidney disease, kidney exclusion due to various pathologies, such as UPJ obstruction, reflux nephropathy, among others, indications of malignant tumors, particularly Wilms tumor are increasing legitimizing itself through corresponding treatment protocols, and surgery performed while adhering strictly to oncological surgical rules. [74].…”