“Robotic-assisted surgery in children: advantages and limitations.”
Al-Bassam, A. (2010).
Journal of Robotic Surgery: 1-4.
The use of surgical robots in minimally invasive surgery was developed to overcome difficulties seen with conventional laparoscopic surgery. I report my experience with pediatric robotic-assisted surgery and highlight its feasibility, safety, advantages, and limitations. Children and infants included in this study underwent robotic-assisted laparoscopic procedures performed by the author, using the original da Vinci surgical system, between July 2005 and July 2008. Their medical records were reviewed with respect to demographic data, robot setup times, techniques and operative procedures, complications, outcomes, and follow-up duration. Forty-three patients (20 female, 23 male), ranging in age from 2.5 months to 16 years, underwent 46 robotic-assisted procedures. Mean setup time was 17.6 min. One primary and two to four working ports were used, allowing insertion of 5- and 8-mm robotic instruments. Five- and 11-mm telescopes were used based on patient size. All procedures were successfully completed except for two. The most common procedure was Nissen fundoplication (N = 26). There were no intraoperative complications or deaths, but three patients developed postoperative complications. Mean follow-up time was 12 months. Robotic-assisted surgery in children is safe, feasible, and applicable to a wide range of procedures. Advantages include improved visibility, dexterity, and ergonomics, although it does have certain limitations. Technological refinements will allow its use in more complex procedures, with probable greater use of robots in pediatric surgery. © 2010 Springer-Verlag London Ltd.
“Advances in Minimally Invasive Surgery in Pediatrics.”
Blatnik, J. A. and T. A. Ponsky (2010).
Current Gastroenterology Reports: 1-4.
The field of pediatric surgery has undergone numerous changes throughout the past few years. When laparoscopic surgery was introduced, pediatric surgeons were reluctant to change their practice because many of the instruments were not appropriate for their tiny patients. Shortly thereafter, the development of pediatric laparoscopic surgery was followed quickly by advanced pediatric laparoscopy, which has allowed pediatric surgeons to repair esophageal atresia and pyloric stenosis through the smallest of incisions. The future direction of minimally invasive pediatric surgery involves single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and robotic surgery. This article reviews the recent advances in minimally invasive pediatric surgery, and the direction we foresee for the field. © 2010 Springer Science+Business Media, LLC.
“Straight-arm positioning and port placement for pediatric robotic-assisted laparoscopic renal surgery.” Chandrasoma, S., P. Kokorowski, et al. (2010).
Journal of Robotic Surgery: 1-4.
Minimally invasive procedures are gaining in popularity for application in reconstructive surgeries of the kidney in children. The use of robotic assistance for these laparoscopic procedures is an emerging option. Here, we describe our straight-arm positioning technique, which serves as a simple and effective alternative to classic flank positioning in pediatric renal cases, and the associated port placement strategies for these robotic-assisted laparoscopic reconstructive renal procedures. © 2010 Springer-Verlag London Ltd.
“Initiation of a pediatric robotic surgery program: institutional challenges and realistic outcomes.”
Sorensen, M. D., M. H. Johnson, et al. (2010).
BACKGROUND: Few institutions have reported their experience initiating a pediatric robot-assisted laparoscopic (RAL) program, and results vary regarding the outcomes for robotic surgery in children. We present the initiation of our pediatric robotic surgery program, provide suggestions for overcoming institutional challenges, and perform a comparative analysis to illustrate realistic outcomes during the learning curve. METHODS: Outcomes from consecutive children who underwent RAL surgery since the 2006 acquisition of the da Vinci((R)) surgical system were retrospectively reviewed. To evaluate the safety and outcomes during the introduction of this new technology, we performed an outcome analysis of ureteral reimplantations comparing RAL cases to matched open controls. RESULTS: The first 50 RAL cases were performed over 20 months by two general and two urologic surgeons. Fourteen different procedures were performed successfully. The average patient age was 8.6 +/- 5.7 years with 10 patients weighing less than 10 kg (20%). Three urologic cases were converted to traditional laparoscopy and two general surgery cases were converted to open. There were five mechanical failures. Initial outcomes comparing RAL and open ureteral reimplantations revealed similar length of stay, complications, and success with lower estimated blood loss in the RAL group. Overall OR time was 53% longer in the RAL reimplant group (361 +/- 80 vs. 236 +/- 58 min, p < 0.0001). CONCLUSION: Robotic surgery appears to be safe in pediatric patients for many procedures. Proper instruction and training precedes technological proficiency. The institutional learning curve may be magnified when there are multiple participating surgeons. Operative times for initial RAL cases can be expected to be greater than their open correlates.