Establishing a pediatric robotic surgery program in Canada

Despite the introduction of robotic surgery in 2000, few pediatric surgeons outside the United States have embraced this technology. We discuss our experience with establishing the first Canadian pediatric robotic surgery program. After simulator training, live animal surgery and observation of robotically assisted cases at an outside institution, we performed our first pediatric da Vinci^® surgery in July 2013. A prospective database was established to assess outcomes. Forty one children have undergone robotically assisted surgery for the following 42 procedures: (a) pyeloplasty (17), (b) ureteral reimplantations (12), (c) uretero-uretostomy (1), (d) cholecystectomies (10), (e) interval appendectomy (1) and (f) distal pancreatectomy (1). The average age was 9.7 years (range 1.6-17.9) and 66% of patients were female. Average operative time was 174 min (range 47-301). Length of stay was 3 days (range 0-20). All procedures were completed without conversion to open or laparoscopy. There were no technical failures. Two post re-implantation patients had urine leaks which required conservative treatment. Despite the lack of haptic feedback, we have noted that the markedly enhanced three-dimensional visualization and instrument dexterity offer significant advantages for complex reconstructive pediatric surgery. This platform may also enable trainees to perform more advanced minimally invasive pediatric surgery. We have successfully established the first pediatric robotic surgery program in Canada. Our da Vinci^® system is shared with our adult colleagues, which enables more frequent use as well as some cost sharing. A dedicated group of operative nurses and surgeons are required to allow adoption of this new technology.