Robotic-assisted surgery in children: advantages and limitations

The use of surgical robots in minimally invasive surgery was developed to overcome difficulties seen with conventional laparoscopic surgery. I report my experience with pediatric robotic-assisted surgery and highlight its feasibility, safety, advantages, and limitations. Children and infants included in this study underwent robotic-assisted laparoscopic procedures performed by the author, using the original da Vinci surgical system, between July 2005 and July 2008. Their medical records were reviewed with respect to demographic data, robot setup times, techniques and operative procedures, complications, outcomes, and follow-up duration. Forty-three patients (20 female, 23 male), ranging in age from 2.5 months to 16 years, underwent 46 robotic-assisted procedures. Mean setup time was 17.6 min. One primary and two to four working ports were used, allowing insertion of 5- and 8-mm robotic instruments. Five- and 11-mm telescopes were used based on patient size. All procedures were successfully completed except for two. The most common procedure was Nissen fundoplication (N = 26). There were no intraoperative complications or deaths, but three patients developed postoperative complications. Mean follow-up time was 12 months. Robotic-assisted surgery in children is safe, feasible, and applicable to a wide range of procedures. Advantages include improved visibility, dexterity, and ergonomics, although it does have certain limitations. Technological refinements will allow its use in more complex procedures, with probable greater use of robots in pediatric surgery.