Robotically assisted esophago-esophagostomy in newborn pigs.

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Repair of esophageal atresia and tracheoesophageal fistula (TEF) is challenging in newborns.
• Minimally invasive surgery (MIS) for TEF is rarely attempted due to technical difficulties.
• Robotic surgical systems offer enhanced dexterity and precision for complex procedures.

Purpose of the Study:

• To evaluate the feasibility of robotic assistance for MIS repair of TEF in a newborn animal model.
• To assess the safety and efficacy of robotic esophageal anastomosis in a confined surgical space.

Main Methods:

• Seven newborn pigs underwent esophageal resection and end-to-end anastomosis using the Zeus Microwrist Robotic Surgical System.
• Surgical metrics including set-up, dissection, and anastomosis times were recorded.
• Postoperative outcomes were assessed via esophagram and histopathology after 1 month.

Main Results:

• Two pigs died postoperatively from unrelated causes; neither showed anastomotic leak.
• Esophagrams of surviving pigs showed no narrowing in 2, and stenosis requiring dilation in 3.
• Histopathology revealed well-healed anastomoses in 2 pigs and focal ulceration in 5.

Conclusions:

• Robotic assistance can facilitate minimally invasive surgery for upper esophageal procedures in neonates.
• The robotic system's capabilities may overcome the challenges of limited space in infant thoracic surgery.
• Further research is warranted to explore the full potential of robotic surgery in pediatric TEF repair.