Ten years of paediatric robotic surgery: Lessons learned

Abstract

Background: Costs and a low total number of cases may be obstacles to the successful implementation of a paediatric robotic surgery programme. The aim of this study was to evaluate a decade of paediatric robotic surgery and to reflect upon factors for success and to consider obstacles. Materials and Methods: All children operated on with robotic-assisted laparoscopic surgery between 2006 and 2016 were included in a retrospective, singleinstitutional study in Lund, Sweden. Results: A total of 152 children underwent robotic surgery during the study time with the most frequent procedures being fundoplication (n = 55) and pyeloplasty (n = 53). Procedure times decreased significantly during the study period. Overall, 18 (12%) of the operations were converted to open surgery, and seven (5%) patients required a reoperation. Conclusions: Despite a low volume of surgery, we have successfully introduced robotic paediatric surgery in our department. Our operative times and conversion rates are continuously decreasing.

Robotic Assisted Endoscopic Surgery Practices in Pediatric Surgery, Single Center Experience

“…(1). While this rate was initially 36% in pyeloplasty and 40% in hemi nephrectomies, it has been reported to decrease in that rate rapidly with the increase in cases (1). The most important reasons for conversion to open surgery are; the high body mass index of the patient, severe anatomical problems, and technical reasons that have been reported (1).…”

“…Two children The learning curve of RALS is much shorter than endoscopic surgery, however in conventional endoscopic surgery, It takes a long time to acquire the sufficient skill. Moreover, studies have shown that RALS has a shorter learning curve (1,(3)(4)(5)(6). At the same time, important limitations of RALS include the lack of tactile feedback, but this deficiency can be overcome over time by the brain's evaluation of visual data (7).…”

“…Today, although robotic-assisted laparoscopic surgery (RALS) applications have entered into routine clinical use in adults, it is still not possible to say the same for pediatric surgery (1). The first pediatric case (Nissen fundoplication) was reported only ten years after RALS in adults (2).…”

A Comparative Analysis of Robot-Assisted Laparoscopic Pyeloplasty in Pediatric and Adult Patients: Does Age Matter?

“…The introduction of robotic surgery in children has been slower, although it showed promising results [ 10 , 11 ]. RALP in pediatric patients has been reported to be associated with shortened operating hours, shortened postoperative hospital stays, low complication rates, and high surgical success rates [ 12 , 13 , 14 ]. Recent studies even suggest that age is not even considered a factor when deciding the need for robotic surgical intervention because significant benefits with RALP can be generally expected [ 15 ].…”

“…Recent studies even suggest that age is not even considered a factor when deciding the need for robotic surgical intervention because significant benefits with RALP can be generally expected [ 15 ]. However, although such radical proposals are constantly being suggested, research comparing the outcomes of RALP between children and adults remains insufficient [ 12 , 13 , 14 ]. Therefore, in this study, we assessed the outcomes of robotic pyeloplasty performed in children and adults and examined whether age should be considered an influencing factor for surgical indication.…”