“14-Gauge angiocatheter: The assist port.”
Hotaling, J. M., S. Shear, et al. (2009).
Journal of Laparoendoscopic and Advanced Surgical Techniques 19(5): 699-701.
Introduction: Minimally invasive techniques have emerged as the standard of care for some procedures in pediatric urology. In an effort to minimize required ports for robotic-assisted laparoscopic (RAL) surgeries in children, we describe in this article a novel technique for using a 14-gauge (G) angiocatheter as an assist port in concert with various readily available cystoscopic equipment. Materials and Methods: After the insertion of robotic ports and docking, the da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA), using a 14-G angiocatheter, was placed through the abdominal wall under direct vision. The 14-G angiocatheter was then used to facilitate stent placement, provide a port for semiflexible cystoscopic graspers, and to evacuate cautery smoke. At the end of each case, the 14-G angiocatheter was removed under direct vision prior to undocking the robot. Results: A 14-G angiocatheter was used as an assist port in 17 RAL urologic procedures (16 RAL dismembered pyeloplasties and 1 robotic orchiopexy). No complications occurred and the angiocatheter’s use avoided the placement of 3- or 5-mm additional assist ports. Conclusions: The 14-G angiocath technique uses existing equipment, requires no closure, and can be placed anywhere on the abdominal wall. It allows the RAL dismembered pyeloplasty to be performed with only two instrument ports and no additional trocar for assistance. This is the first described method in the urologic literature of using a 14-G angiocatheter to maximize operative assistance while minimizing port placement in pediatric RAL surgery. © 2009, Mary Ann Liebert, Inc.
“Robotic surgery in small children: Is there room for this?”
Meehan, J. J. (2009).
Journal of Laparoendoscopic and Advanced Surgical Techniques 19(5): 707-712.
Some pediatric surgeons may be reluctant to use robotic surgery for small patients because the only available surgical robot might seem too large for smaller patients. However, we have found this concern invalid. We have been successful in a wide variety of Minimally Invasive Surgery procedures using robotics for general surgery applications in small children. However, several technical issues must be considered in order to optimize this technology for these children. In this article, we present a retrospective review of 45 patients of less than 10′kg who underwent robotic surgery and discuss the adjustments we made in order to adapt this technology to our small patients in a wide variety of general surgical procedures. © 2009, Mary Ann Liebert, Inc.
“Pediatric Robotic Surgery: Early Assessment.”
van Haasteren, G., S. Levine, et al. (2009).
Objectives: This article reviews the evidence regarding the feasibility, safety, benefits, limitations, and costs of robotically assisted surgery in children, evaluates how the technology compares with other pediatric surgical techniques, and provides insights about the near and more-distant future of the technology. Methods: The peer-reviewed medical pediatric literature was searched for studies that provided evidence of the feasibility and safety of robotic surgery in children and for studies that compared pediatric robotic surgery with conventional laparoscopic surgery or open surgery. Results: A total of 8 case series and 5 studies comparing robotic surgery with open or conventional laparoscopic surgery met the selection criteria for review. A few small studies that focused on rare complex surgical procedures also were reviewed. All studies were designed to evaluate the feasibility and safety of robotic surgery in children. None of the studies was randomized, and some studies had a retrospective design. These studies demonstrated that a number of routine, robotically assisted, laparoscopic and thoracic procedures were feasible and safe when performed by surgeons experienced in the technique, although robotic surgery did not provide superior outcomes, compared with traditional laparoscopic and open surgery. The advantages of the robotic system were best seen in complex procedures that involved areas that were difficult to access and in procedures in which dissection of delicate, anatomic structures was required. Conclusions: Robotic surgery is feasible and safe for a number of pediatric surgical procedures, but evidence that it offers better clinical outcomes than conventional open or laparoscopic techniques is lacking.