Thoracic surgery by minimally invasion robot-assisted in children: “experience and current status”

Abstract

Aim: We report our experience in minimally invasive thoracic robot-assisted surgery in children, and a current analysis is carried out on this topic. Methods: Observational, prospective, and longitudinal studies were performed for children with thoracic pathology treated with robotic surgery, from March 2015 to April 2019. We used the "da Vinci surgical system" (Intuitive Surgical, Inc., Sunnyvale, CA. USA). Registered variables included demographic data, diagnosis, surgery, total time, time of console surgery, bleeding, hemotransfusions, conversions, complications, postoperative (PO) stay, and follow-up. Measures of central tendency were used. Research Ethics Committee of Hospital approved the study. We conducted a detailed non-systematic review of previous publications of children undergoing thoracic robotic surgery. Results: We treated 11 children, with average age of 5.7 years and weight of 21.3 kg. Diagnosis were: congenital cystic adenomatoid malformation, intralobar sequestration, diaphragmatic paralysis, diaphragmatic eventration, mediastinal teratoma, Ewing's tumor of the fourth left rib, and pulmonary tuberculosis. Surgeries performed were: four lobectomies, four diaphragmatic plications, two tumor resections, and a case of pleural and lung biopsies. The average of console surgery time was 166.45 min, PO stay was 3.6 days, and follow-up was 24.7 months. Conversions and PO complications were 9.1%, and there were no intraoperative complications and mortality. Currently, the number of children treated with thoracic robot-assisted surgery has barely reached 100 cases. Conclusion: Our results are encouraging, although our experience is limited to a few cases. Robotic surgery for the treatment of thoracic pathology is feasible and safe, and has advantages. To date, very few patients have been treated, and few pediatric surgeons worldwide have applied thoracic robotic surgery in children.

Robotic-Assisted Minimally Invasive Surgery in Children

“…Thoracic MIS reduces the risk of thoracic and spinal deformities after lung resection in children. Lobectomy is one of the robotic techniques most frequently performed in children [133].…”

“…Overall, there were 6 (18%) conversions to open surgery in neonatal patients and (3) 9% postoperative complications. The neonatal thorax represents the greatest obstacle in the adaptation of the 5 or 8 mm robotic platform instruments [20,133,136]. In RATS, children weighing more than 4 kg are more easily treated [15].…”

“…The first publication on robotic lobectomy, including pediatric cases, was by Park et al [137], in 2006. Series with few cases of segmental lung resections and lobectomies have been published with excellent results with conversions mainly on the first attempt [14,15,133,136]. Addressing the disadvantages of RATS lobectomy, a prolonged total operative time was reported, but without having a negative effect, since it did not increase the postoperative morbidity and mortality of patients [138].…”

“…Previously, we published our experience with RALTS, the first 186 surgeries [14], the first 4 cases of choledochal cyst resection [109], redo Nissen fundoplication [114] and in thoracic surgery [133].…”

Latest Developments in Medical Robotics Systems

“…Overall, there were 6 (18%) conversions to open surgery in neonatal patients and (3) 9% postoperative complications. The neonatal thorax represents the greatest obstacle in the adaptation of the 5 or 8 mm robotic platform instruments [20,133,136]. In RATS, children weighing more than 4 kg are more easily treated [15].…”