Robotic Assisted Surgery in Pediatric Urology: Current Status and Future Directions

Chen, Catherine J.; Peters, Craig A.

doi:10.3389/fped.2019.00090

Cited by 11 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More recently, novel fields of application of RAS including thoracic surgery, cardiac surgery, otolaryngology, and pediatric surgery, have been discovered with encouraging results. 2,3 RAS has been mainly adopted to perform reconstructive procedures in children, demonstrating the consistent advantage to overcome the technical challenges of such procedures compared with conventional laparoscopy as robotic arms have 7°of freedom and can articulate up to 90°. 4,5 Other advantages related to the use of EndoWrist technology include three-dimensional (3D) high-definition view of the operative field, and improved ergonomics since the surgeon can operate seated on the robotic console, with alignment of eyes and hands' position with the instruments and elimination of hands' tremor.…”

Section: Introductionmentioning

confidence: 99%

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Esposito

Masieri

Castagnetti

et al. 2023

Journal of Laparoendoscopic & Advanced Surgical Techniques

View full text Add to dashboard Cite

Background: Pediatric robot-assisted surgery (RAS) is gaining increasing acceptance. We aimed to assess the diffusion of pediatric RAS in Italy, the training period, indications, preliminary outcomes, and limitations. Materials and Methods: An online questionnaire-based survey was performed. The data about robotic activity of 9 Italian Pediatric Surgery units were collected and analyzed. Results: Most of the participating centers (7/9, 77.8%) started RAS less than 5 years ago with only 2 centers (22.2%) performing RAS since 2010. The training included dry-lab in 5/9 centers (55.5%), wet-lab in 5/9 centers (55.5%), and robot simulator in 7/9 centers (77.8%), followed by an exam to obtain a certificate. The average duration of training was 23.7 hours (range 5-50). A total of 209 robotic procedures was performed in all centers during the period 2010-2018 and included 119 urological (56.9%), 31 gynecological (14.8%), 41 gastrointestinal (19.6%), 12 oncological (5.7%), and 6 other (2.8%) procedures. The docking time significantly fell down after 18 robotic procedures (P = .001). Intraoperative complications were recorded in 4 cases (1.9%). Conversion to laparoscopy was needed in 4 cases (1.9%) whereas conversion to open was required in 6 cases (2.8%). Postoperative complications occurred in 17/209 cases (8.1%) and were graded Clavien I-II in 14 cases (6.7%) and Clavien IIIb in only 4 cases (1.9%). Conclusions: Our study confirmed that RAS has still a limited diffusion in Italy for pediatric patients. Before starting robotic activity, pediatric surgeons have to obtain a certificate after a virtual and experimental training period. A mentorship clinical period of 10 cases under supervision of a proctor is also needed. The main indications in children remain reconstructive urological procedures. RAS is safe in children but its applications are currently limited to patients older than 2 years and with a weight >15 kg, due to the size of robotic ports.

show abstract

Section: Introductionmentioning

confidence: 99%

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Esposito

Masieri

Castagnetti

et al. 2023

Journal of Laparoendoscopic & Advanced Surgical Techniques

View full text Add to dashboard Cite

show abstract

“…The past three decades have seen diversified applications of MIP in the field of surgical treatment, especially after the robot-assisted surgical system was approved by the Food and Drug Administration (FDA) in 2000. 9 In the pediatric urologic treatment field, most of the robot-assisted surgeries were reconstructive procedures, such as pyeloplasty, ureteral reimplantation, and even appendicovesicostomy. [10][11][12] However, the role of robot-assisted MIP in the treatment of pediatric solid tumor remains less accepted than open surgery.…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Laparoscopic Management of Bladder/Prostate Rhabdomyosarcoma in Children: Initial Series and 1-Year Outcomes

Пин

Zhou

Cao³

et al. 2021

Journal of Endourology

View full text Add to dashboard Cite

Objective: To present our preliminary experiences of robot-assisted laparoscopic radical or partial cystectomy for bladder/prostate rhabdomyosarcoma (B/P RMS) in children. Methods: A retrospective study was conducted with children who underwent robot-assisted laparoscopic surgery for B/P RMS between July 2018 and March 2020 under the approval of IRB of our center. The patient characteristics, tumor position, perioperative information, short time oncologic survival outcomes, and urinary function were recorded and evaluated. Results: We identified eight children who underwent robot-assisted laparoscopic surgery for B/P RMS. Partial cystectomy was performed on all, but one, patients, who underwent radical cystectomy and sigmoid neobladder reconstruction. Preoperative chemotherapy was administered to all eight patients, while preoperative radiotherapy was conducted in three cases, including one patient with a history of pelvic RMS. Unilateral/bilateral ureteral reimplantation was done in four cases in which the patients' ureteral orifices were involved. The mean follow-up time was 13.3 months, and no local recurrence or metastasis was observed. No patient experienced urinary incontinence eventually. Conclusion: Robot-assisted laparoscopic resection for bladder RMS in children is safe and feasible. Preoperative radiotherapy could decrease the tumor volume so that the membranous urethra could be preserved for as long as possible. The oncologic efficacy and the overall survival rate require further investigation and longer follow-up.

show abstract

“…Given the constraints imposed by the robotic instruments and potential anatomical space limitations of the patient, the use of RAS in patients less than 1 year old or weighing less than 10 kg remains especially challenging, although there are reports of RAS being performed on patients weighing less than 7 kg [6,8,12,15,16]. There is currently no consensus on pediatric patient selection for RAS and there are no established parameters to guide this decision [8].…”

Section: Patient Selectionmentioning

confidence: 99%

“…• The limited number or size of studies • Important flaws in study design or methods • Inconsistency of findings across individual studies • Gaps in the chain of evidence • Findings not generalizable to routine primary care practice • Lack of information on important health outcomes More information may allow estimation of effects on health outcomes 2. Robotic surgery can be considered mainly in patients weighing more than 10 kg and older than one year [8,9,12,15,16,18,[20][21][22][23] (Grade A-Level High) 3. Based on the experience at individual centers, robotic surgery can also be performed in selected patients of lower weight or age [8,9,12,15,18,[20][21][22][23] (Grade C-Level High) 4.…”

Section: Highmentioning

confidence: 99%

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

et al. 2022

View full text Add to dashboard Cite

Background Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally. Methods A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place. Results During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management. Conclusion Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.

show abstract

Robotic Assisted Surgery in Pediatric Urology: Current Status and Future Directions

Cited by 11 publications

References 21 publications

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions

Robot-Assisted Laparoscopic Management of Bladder/Prostate Rhabdomyosarcoma in Children: Initial Series and 1-Year Outcomes

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

Contact Info

Product

Resources

About