Ann Surg Treat Res.  2024 Jun;106(6):322-329. 10.4174/astr.2024.106.6.322.

Robotic surgeries in pediatric patients: an early experience in a single center

• Jeong YC
• Kang A
• Ko DY
• Youn JK
• Kim HY

• KMID: 2556323
• DOI: http://doi.org/10.4174/astr.2024.106.6.322

Abstract

Purpose
Robotic surgery (RS) has the advantages of 3-dimensional view, optical magnification, motional scaling, and improved ergonomics and degree of freedom. Although RS has widely been performed on pediatric patients lately, there are still numerous restrictions and ambiguous indications. The purpose of this study was to report our early experience with RS on pediatric patients at a single center.
Methods
Electronic medical records of patients who underwent RS with the da Vinci Xi surgical platform (Intuitive Surgical, Inc.) in Seoul National University Children Hospital from November 2019 to August 2021 were reviewed retrospectively. The median follow-up was 21.0 months (range, 12.3–31.8 months). An online survey was conducted to investigate satisfaction with robotic surgical scars.
Results
Fifty-four patients underwent robotic surgeries (median age at operation, 11.1 years [range, 0.1–17.8 years]). In our hospital, patients had 20 different kinds of robotic surgeries, including choledochal cyst excision with hepaticojejunostomy, ovarian mass excision, and others. Median operation time and console time were 157.5 minutes (range, 45–505 minutes) and 40 minutes (range, 11–360 minutes), respectively. All cases were done without conversion into open or laparoscopic methods. Postoperative complications were found in 5 patients. According to an online survey, over half of patients (60.9%) answered that they felt satisfied with scars.
Conclusion
Our early experience demonstrated the safety and feasibility of RS in children with a range of diagnoses and complicated procedures. With more experience, RS could be an alternative to traditional open or laparoscopic operations in pediatric patients. Further studies are needed to clarify indications of pediatric RS.

Keyword

Choledochal cyst, Minimally invasive surgical procedures; Pediatrics, Robotic surgical procedures

Figure

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  Fig. 1 Hybrid choledochal cyst excision with hepaticojejunostomy. (A) Four trocars, including a subumbilical camera port and additional 3 trocars, were placed. (B) A 1-month-old girl underwent magnetic resonance cholangiopancreatography for evaluation of the biliary tract before the operation, and a choledochal cyst (Todani type I) was identified. a, choledochal cyst; b, common hepatic duct; c, cystic duct; d, gallbladder; e, distal common bile duct. (C) Robot-assisted hepaticojejunostomy after choledochal cyst excision.

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