Conversion Rate in Pediatric Robotic-Assisted Surgery: Looking for the Culprit

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic-assisted surgery (RAS) is gaining traction in adult procedures but remains less explored in pediatric cases.
• Initial experiences with pediatric RAS are crucial for understanding its feasibility and challenges.

Purpose of the Study:

• To report the initial experience with pediatric robotic-assisted surgery.
• To analyze the causes of conversion to open surgery in pediatric RAS.

Main Methods:

• A retrospective analysis of pediatric patients undergoing RAS between June 2015 and April 2019.
• Data collected included demographics, comorbidities, prior surgeries, and intraoperative surgical and anesthetic parameters.
• A three-arm robotic technique was employed, with additional laparoscopic ports used as needed.

Main Results:

• Thirty-nine patients underwent 40 procedures; 7.5% (3 cases) were converted to open surgery.
• Conversions were primarily due to inadequate working space (e.g., bowel distension, insufficient retraction).
• Converted patients were significantly younger and lighter than those who completed the procedure robotically. Anesthetic factors and bowel preparation methods did not show statistical differences.

Conclusions:

• The conversion rate in this initial pediatric RAS program is deemed acceptable.
• Inadequate working space is the main driver for conversion in pediatric RAS, particularly in younger, smaller patients.
• Anesthetic management and bowel preparation regimens do not appear to significantly influence the need for conversion in pediatric RAS.