Robotic Neck Surgery in the Pediatric Population

Abstract

Introduction:Thyroid, parathyroid, and thymus surgeries are traditionally performed via a cervical approach. However, robot-assisted procedures can provide a safe alternative for neck surgeries. We report our experiences with robotic transaxillary and retroauricular approaches in pediatric patients.Case Presentation:We conducted a retrospective review of pediatric patients who underwent robot-assisted neck surgery by a single surgeon between April 2010 and May 2017. Patient demographics and surgical outcomes including operative time, incidence of complications, and length of hospital stay were evaluated.Management and Outcomes:Nine surgeries in 7 female patients were reviewed (mean age, 16.0 ± 1.58 years; mean body mass index, 22.5 ± 0.75). Two thyroid lobectomies, 2 complete thyroidectomies, 1 subtotal thyroidectomy, 1 thyroid lobectomy with thymectomy, 2 subtotal parathyroidectomies with thymectomy, and 1 dermoid cyst excision were performed. Two surgeries with the retroauricular approach had a mean surgical time of 142.0 ± 6.13 minutes. Seven surgeries with the transaxillary approach had a mean surgical time of 146.1 ± 21.01 minutes. There were no reported conversions, permanent vocal cord paralysis, permanent hypoparathyroidism, hematoma, or seroma. There was 1 case (11%) of temporary shoulder hypoesthesia and 2 cases of temporary vocal cord paresis (22%).Discussion:This series on robot-assisted neck surgeries in children describes procedures performed with robotic transaxillary and retroauricular approaches. In the hands of a high-volume surgeon the techniques are feasible and safe options for operations in the neck in a select group of pediatric patients.

Comparison of Surgical Outcomes between Robotic Transaxillary and Conventional Open Thyroidectomy in Pediatric Thyroid Cancer

“…BMI was similar between the two groups (robotic: 22.2 ± 3.9 (14.1-39.7) kg/m 2 vs. open: 22.0 ± 4.8 (13.2-35.9) kg/m 2 , p = 0.425). In previous studies from the United States, RT in pediatric patients was limited by the patient's BMI, but in our institution, the BMI range of RT was 13.2-35.9 kg/m 2 [13,27]. Thus, this shows that RT is not affected by the patient's BMI (underweight to obese).…”

“…The strength of this study was that it compared surgical outcomes between RT and COT using a large series of pediatric patients. Numerous studies have shown the advantages of RT in adult patients who had excellent outcomes, and these advantages are also applicable to the pediatric population [12][13][14][15][16][17]20,21,25,26,34,35]. First, a three-dimensional working field with a magnified view provided by robotic systems permits visual accuracy for smaller strictures in pediatric patients, and tremor-filtering multiarticulated instruments enable a wide range of surgical treatments involving small incisions and precise, meticulous manipulation of the surgical tissues in children with thyroid cancer.…”

“…Thyroid cancer in advanced stages with local or distant metastasis at the time of diagnosis and recurrence is more common in children than in adults, but the prognosis remains very favorable [1][2][3][4][5][6]. The important clinical, molecular, and pathological differences Cancers 2021, 13, 3293. https://doi.org/10.3390/cancers13133293 https://www.mdpi.com/journal/cancers in differentiated thyroid cancer among children compared to that in adults have prompted the development of unique pediatric guidelines. The American Thyroid Association (ATA) published guidelines for pediatric thyroid cancer in 2015 in consideration of the underlying biologic and molecular differences between pediatric and adult thyroid cancer [2,7].…”

“…Robotic transaxillary thyroidectomy (RT) for pediatric patients was first reported by Lobe et al in 2005 [12]. Since then, only a few studies have reported on the applicability of robotic surgery for pediatric patients with thyroid cancer, although there are already many reports on the advantages of RT for adults with large patient series showing similar oncologic outcomes and morbidity and better cosmetic results than conventional open thyroidectomy (COT) [13][14][15][16][17].…”

Robot-assisted gallbladder-preserving hepatectomy for treating S5 hepatoblastoma in a child: A case report and review of the literature

“…The development of paediatric surgical robotic surgery in China is in its infancy, and the therapeutic effects of paediatric surgery are influenced by various factors, such as the child’s age, disease status, anatomical positions of the lesions, posture, and surgical complexity, which also enable robotic surgery to give full play to its advantages in the field of paediatric surgical treatment[12-16].…”