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

Abstract

AimThe use of robotics-assisted surgery in oncology has been proved effective and safe in adults. Despite these results, the use of robotics has been rarely reported for pediatric oncology. Our review aims to evaluate the safety and feasibility of robotics-assisted surgery in this field, analyzing our experience and performing a systematic review of the most recent studies.MethodsWe reviewed all patients affected by an oncological disease who underwent a robotics-assisted procedure at our institute. We performed a systematic review of the literature from 2012 to 2021 on the subjects.FindingsA total of 14 patients underwent robotics-assisted tumor resection. Eleven procedures (median age 13.2-years old) were carried out in children with adnexal lesions (seven tumor excision and four ovariectomies). Histological diagnosis was mature teratoma (six), serous papillary cystadenofibromas of the fallopian tube (two), ovarian serous cystadenoma (one), ovarian mucinous cystadenoma (one), and ovarian seromucinous cystadenoma. The median length of stay was 2 days. No recurrences or complications at a median follow-up of 2.1-years were observed. A 5-year-old girl underwent a complete posterior resection of a type 3 sacrococcygeal tumor with a robotics-assisted approach for the dissection of a possible intraabdominal residual component of the lesion. No intra- and postoperative complications were recorded. Complete excision of a recurrent differentiating neuroblastoma of the left para-renal region was performed on a 9-year-old girl. An idiopathic anaphylactic shock occurred 1 day after the procedure. At 9 months' follow-up, no local recurrences of the lesion were observed. Overall, we reported no conversion to open surgery. Lastly, a robotic excision of a growing left superior mediastinal intermixed ganglioneuroblastoma was performed on an 8-year-old girl with no postoperative complications. Follow-up was uneventful (7 months). In the literature, the rate of complications ranges from 0 to 28%, mainly related to difficult dissection and impaired anatomy. Conversion is reported in 5% of all oncological procedures, due to more invading tumors and altered anatomical features. No robotics-related complications were reported.ConclusionRobotics-assisted surgery in pediatric oncology has proven to be feasible. Nevertheless, its use should be limited to selected cases and performed by highly trained oncological surgeons. Preparation and patient positioning, alongside a correct port placement, are crucial to carrying out these procedures. Further innovations in robotics may allow a wider application of this technology in pediatric oncology.

Narrative review: robotic pediatric surgery—current status and future perspectives

“…Even if robot-assisted surgery in oncology has been demonstrated to be effective in adult population, in pediatric age its use is still limited with few studies conducted on this subject. This could be probably due to the scarce incidence of this disease and to the characteristic of pediatric tumors, which frequently presented a rapid growth, with the need of other non-surgical approach, such as neoadjuvant chemotherapy or radiotherapy ( 74 ).…”

“…Various oncological procedures for different kind of pediatric tumors were described in literature, such as nephroblastomas, adrenals tumors, pancreatic tumors, germ-cell tumors, thymic tumors, shifting through malignant, borderline or benign tumors. Nephroblastomas and ovarian tumors are most frequently illustrated ( 74 - 77 ). Robot-assisted laparoscopy for abdominal or pelvic tumors, robot-assisted retroperitoneoscopy or robot-assisted thoracoscopy were described.…”

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

“…CPAM: Congenital pulmonary airway malformation tumors out of 134 patients (14). Blanc et al (15) reported their experience with 100 oncologic patients and formulated a guideline for patient selection.…”

Application and prospects of robotic surgery in children: a scoping review

“…Vatta et al conducted a retrospective analysis of 14 children who received robot-assisted tumor resection. 56 The tumors involved included mature teratoma, serous papillary cystadenofibromas of the fallopian tube, ovarian cystadenoma, type 3 sacrococcygeal tumor, neuroblastoma and intermixed ganglioneuroblastoma. All tumors were successfully resected without conversion to open surgery, and no recurrence or complications occurred during follow-up.…”