Early experience of tele-robotic surgery in children

The application of robotic technology in paediatric and adult surgery is limited. We report our early experience in children.

Selected children from the age of 3 years who underwent da Vinci robotic surgery were included. All procedures were carried out by the senior author (A.N.), using three robotic ports and an accessory laparoscopic port if and when necessary. The telescope port was placed using an open technique and all port sites were closed in layers at the end of the procedure. Post-operatively all patients were offered overnight intravenous morphine. All data was collected prospectively.

During March 2006-July 2007 there were 50 procedures in 40 children: fundoplication (5), fundoplication and gastrostomy (6), Heller's myotomy and fundoplication (2), cholecystectomy (1), splenectomy (1), cholecystectomy and splenectomy (1), re-do rectal mobilization (1), excision of Müllerian remnant and bilateral orchidopexy (1), partial nephroureterectomy (1), nephroureterectomy (4), neprectomy (4) and transperitoneal pyeloplasty (13). The mean age was 10.2 (range 3-17) years. The mean docking time was 11.9 (range 4-20) min. Forty-seven procedures in 37 children were successfully completed. There were three conversions, one robot-related (mechanical failure) and two non-robot-related (severe adhesions, difficulty with placing a guide wire for nephrostent) but no other operative complications. Post-operative complications were not robot-related (one wound infection, one urine extravasation from a displaced ureteric stent). The mean hospital stay was 2.4 (range 1-6) days, and this was affected by the patients' pre-existing clinical and social conditions.

In children robotic surgery is safe and applicable to a wide range of surgical conditions. Further experience is required in order to establish its full potential.