Robotic-Assisted Surgery in Pediatric Gynecology: Preliminary Initial Outcomes

Abstract

Introduction Robotic-assisted surgery has become widely used in adult gynecology, but has not yet been widely used in pediatric patients. We report our initial experience in robot-assisted pediatric gynecologic surgery to determine its feasibility, safety and limitations in children. Methods A retrospective single-center study was performed among consecutive girls under 18-years who underwent ginecologic robotic-assisted procedures in our institution between 2012-2021. A three-arm robot (5 mm trocars) with one camera arm (12 mm trocar) was used in all cases by the same surgical team. Demographic data, type of robotic procedure, surgery time, complication rate, conversion rate to laparoscopic procedure, lenght of hospital stay (LOS) and postoperative complications were analyzed. Results A total of 10 patients were included (median age 11.9 years; range 2.5-17.4 years), who underwent robotic assisted surgery for adnexal pathologies: 3 for ovarian cystectomy, 3 for ovarian teratoma resection, 2 for oophorectomy, 1 for bilateral salpingo-oophorectomy for gonadal dysgenesis and 1 for hysterectomy in a patient with cerebral palsy and recurrent severe uterine bleeding. Median surgery time was 74 minutes (interquartile range: 66-82 minutes). Intraoperative blood loss was minimal (median: 35 ml) Conversion to laparatomy was not necessary in any case. Median LOS was 1 day (interquartile range: 1-2 days). No intra- or postoperative complications occurred. Conclusion Preliminar outcomes indicate that ginecologic robotic-assisted surgery is effective and safely applicable in the pediatric population. However, it is still too early to conclude that it provides better clinical outcomes than traditional laparoscopic surgery. Further prospective, comparative studies are still needed. Type of study: Observational retrospective study Level of evidence: IV