Robotic Surgery: Is There a Possibility of Increasing Its Application in Pediatric Settings? A Single-Center Experience

Abstract

Introduction: Robotic surgery has shown explicit benefits and advantages in adults, but it is not yet strongly established in the pediatric population, even though its popularity is increasing, especially in the urologic field. Materials and methods: In this article we present our experience with the Da Vinci System (SI first and XI nowadays) at our pediatric institution in order to analyze our progress over the years. We considered all patients from the start of the robotic surgery program in 2016 until the end of 2021, dividing them into general abdominal surgery and genitourinary surgery. Analyzed data were the patient’s demographic, details of surgery, and intra and post-operative complications. Results: The total number of patients (pts) included in this study was 76, of whom 40 (52%) were male and 36 (48%) were female. The mean age at surgery was 90.9 months (range 10–207 months), and the mean weight at surgery was 29.3 kg (range 9.5–68 kg). There were 18 general abdominal robotic surgeries and 58 genitourinary robotic surgeries performed. The most performed surgeries in these two categories were fundoplication for gastro-oesophageal reflux disease (11%) and Anderson–Hynes pyeloureteroplasty. The mean operative time was 224.2 min (range 72–530 min): the mean times in the two groups (general abdominal surgery and genitourinary surgery) were 165 min (range 84–204 min) and 194 min (range 95–360 min), respectively. A total of four (5%) minor complications were reported. The total conversions were two (2.6%) and the mortality rate was 0%. Conclusions: Pediatric robotic surgery is a field of considerable interest and it is rapidly expanding. In our experience, it is evident how the learning curve has increased gradually, but steadily, allowing us to advance from standardized surgery, such as fundoplication and pieloplasty, towards a more technically complex one, achieving the same good results. We believe that robotic surgery is very respectful of tissues and feasible, especially for reconstructive surgery. For these reasons, it could become of common use also in the pediatric population, overcoming impediments such as excessive cost and the lack of pediatric instruments, in order to be able to treat children with a progressively lower age and weight.

Pyeloplasty in Children with Ureteropelvic Junction Obstruction and Associated Kidney Anomalies: Can a Robotic Approach Make Surgery Easier?

“…Starting from a laparoscopic learning curve in the abdominal field [ 12 ], we have tried to develop the technique more and more with good results in urological treatment as well [ 13 , 14 ]. In urology in particular, robot-assisted surgery has brought the greatest benefits and the number of procedures performed has increased over time, as has the learning curve for pediatric surgeons [ 7 , 15 ]. Among these, pyeloplasty was one of the first procedures in which robotics became established as an effective technique and currently, robot-assisted laparoscopic pyeloplasty (RALP) represents one of the most frequently performed procedures, even in pediatric settings [ 16 ].…”

“…Pyeloplasty is the gold standard for the treatment of UPJO and since 1995, the year of the first laparoscopic pyeloplasty in pediatric patients [ 4 ], it has been established with a minimally invasive approach [ 5 ]. In recent years, the development of robotic surgery applications in pediatric surgery has raised the bar further, and currently, robot-assisted pyeloplasty is considered a safe and effective approach for the treatment of this pathology [ 6 , 7 , 8 ]. The advantages of robotic surgery over laparoscopic surgery are well known, but in cases of UPJO complicated by the association of other malformations or renal pathologies, the usefulness of the robot-assisted approach is even more readily apparent.…”

Single-port-plus-one robot-assisted laparoscopic Lich–Gregoir direct nipple ureteral extravesical reimplantation in pediatric primary obstructive megaureter, comparing to laparoscopic cohen

“…The modified technique was also used in treatment of POM. With higher definition, fibrillated-free wrist, robot surgery is suitable for pediatric surgery, especially in pelvic narrow cavity, and is a new trend of MIS [ 4 ]. However, there were fewer reports described robot-assisted laparoscopic Lich–Gregoir surgery in POM [ 5 ].…”

Single-port-plus-one robot-assisted laparoscopic modified Lich-Gregoir direct nipple ureteral extravesical reimplantation in children with a primary obstructive megaureter

“…In the past decade, pediatric urologists have frequently implemented minimally invasive procedures by using laparoscopic, robotic-assisted, and other devices. The Da Vinci robot-assisted laparoscopic surgery platform, which is characterized by a 6°freedom articulation, tremor filtering, and stereoscopic vision, provides distinct advantages in intracorporeal reparation and suturing (4). These advantages have expanded the role of robot-assisted surgery in complex lower urinary tract reconstructive surgeries, which are possibly time-consuming due to the narrow pelvic space (5).…”