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How to successfully implement a robotic pediatric surgery program: lessons learned after 96 procedures
Guénolée de Lambert1, Laurent Fourcade, Joachim Centi
1Department of General Pediatric Surgery and Pediatric Urology, CHU Tours, F-37000, Tours, France. guenoleedelambert@gmail.com
Insights
Implementing pediatric robotic surgery requires collaboration between surgeons, nurses, and administration. This approach offers feasible, secure, and successful patient outcomes comparable to conventional methods.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Robotics
Background:
- Pioneering pediatric robotic surgery in France.
- Defining key implementation factors for new robotic surgery programs.
Purpose of the Study:
- To outline essential elements for establishing successful pediatric robotic surgery programs.
- To share insights from the initial implementation of robotic surgery in pediatric care.
Main Methods:
- Retrospective review of 96 pediatric robotic surgeries (Nov 2007 - June 2011).
- Evaluation of patient data, operative details, hospital stay, complications, and outcomes.
- Assessment of departmental and hospital-wide organization, including cost analysis.
Main Results:
- 96 procedures included: 36 general surgery, 57 urologic, 1 thoracic.
- Average operative time: 189 minutes; average hospital stay: 6.4 days.
- Robotic surgery incurred an additional cost of €1934 compared to open surgery, with a 97% success rate.
Conclusions:
- Pediatric robotic surgery is feasible, secure, and yields successful patient outcomes.
- Successful implementation hinges on surgeons, nurses, and administration.
- Robotic surgery programs can achieve comparable quality of care to conventional methods.
Background:
Both our teams were the first to implement pediatric robotic surgery in France. The aim of this study was to define the key points we brought to light so other pediatric teams that want to set up a robotic surgery program will benefit.
Methods:
We reviewed the medical records of all children who underwent robotic surgery between Nov 2007 and June 2011 in both departments, including patient data, installation and changes, operative time, hospital stay, intraoperative complications, and postoperative outcome. The department's internal organization, the organization within the hospital complex, and cost were evaluated.
Results:
A total of 96 procedures were evaluated. There were 38 girls and 56 boys with average age at surgery of 7.6 years (range, 0.7-18 years) and average weight of 26 kg (range, 6-77 kg). Thirty-six patients had general surgery, 57 patients urologic surgery, and 1 thoracic surgery. Overall average operative time was 189 min (range, 70-550 min), and average hospital stay was 6.4 days (range, 2-24 days). The procedures of 3 patients were converted. Median follow-up was 18 months (range, 0.5-43 months). Robotic surgical procedure had an extra cost of
Conclusions:
Our experience was similar to the findings described in the literature for feasibility, security, and patient outcomes; we had an overall operative success rate of 97 %. Three main actors are concerned in the implementation of a robotic pediatric surgery program: surgeons and anesthetists, nurses, and the administration. The surgeon is at the starting point with motivation for minimally invasive surgery without laparoscopic constraints. We found that it was possible to implement a long-lasting robotic surgery program with comparable quality of care.
