Robotic-Assisted Surgery for Gynecological Indications in Children: A Multicenter Experience

Abstract

Robotic-assisted surgery (RAS) is increasingly adopted in the pediatric population. This retrospective multicenter study aimed to report application of RAS for pediatric gynecological indications. The medical records of all children and adolescents with gynecological pathology, operated in 3 different institutions over a 3-year period, were retrospectively collected. Robot docking time, total operative time, length of stay (LOS), requirement time of pain medication, complication rate, conversion rate, and pathology results were analyzed. Sixteen girls, with median age of 11.7 years (range 0.6-17.9) and median weight of 47.2 kg (range 9-73), received the following RAS procedures: ovarian cystectomy for serous cystoadenoma (n=2), salpingo-oophorectomy for immature teratoma (n=6), bilateral gonadectomy for ovotestis (n=2) and Turner syndrome SRY+ (n=1), salpingectomy for fallopian tube lesion (n=1), Gartner cyst excision (n=1), paravaginal ganglioneuroma resection (n=1), fistula closure in urogenital sinus (n=1) and vaginoplasty using ileal flap in cloaca malformation (n=1). Median operative time was 131.3 minutes (range 65-360), and median docking time was 13.9 min (range 7-20). Conversion to open or laparoscopy was not necessary in any case. Median LOS was 2.3 days (range 1-7), and median analgesic requirement was 1.5 days (range 1-4). One patient needed redo-surgery for recurrent Gartner cyst. This preliminary experience showed that RAS is safe and feasible for surgical management of pediatric gynecological pathology, although no conclusive data are available to confirm its superiority over traditional laparoscopy. Randomized, prospective, comparative studies are needed to confirm these preliminary results and identify the gold standard approach in such patients.