Adverse Events and Morbidity in a Multidisciplinary Pediatric Robotic Surgery Program. A prospective, Observational...

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic-assisted laparoscopic surgery (RALS) is increasingly used in pediatric surgery.
• Limited data exists on the one-year morbidity associated with RALS in children.
• A dedicated multidisciplinary pediatric robotic surgery program is essential for comprehensive data collection.

Purpose of the Study:

• To evaluate the one-year morbidity outcomes of robotic-assisted laparoscopic surgery (RALS) in a dedicated pediatric robotic surgery program.
• To assess the safety and efficacy of RALS across a diverse range of pediatric surgical indications.
• To identify factors influencing complications and outcomes in pediatric RALS.

Main Methods:

• Prospective inclusion of all children undergoing RALS (Da Vinci Xi) from October 2016 to May 2020 with a minimum one-year follow-up.
• Analysis of patient demographics, surgical details, intraoperative adverse events (ClassIntra), blood transfusions, hospital stay, and postoperative complications (Clavien-Dindo).
• Statistical analysis to determine the impact of patient characteristics (e.g., ASA score, weight) and surgical factors on outcomes.

Main Results:

• 300 RALS procedures were performed across urology/gynecology, digestive, oncology, ENT, and thoracic surgery.
• Overall, 22% of children experienced complications within one year, with 5% having Clavien-Dindo grade III or higher.
• Robot malfunctions were rare (3%), with a 4% overall conversion rate to laparotomy. Higher ASA scores were associated with complications.

Conclusions:

• Robotic-assisted laparoscopic surgery (RALS) is a safe and effective procedure for pediatric patients, even those with complex conditions and varying ages/weights.
• The study demonstrates a low incidence of robot-specific complications and malfunctions in a dedicated pediatric robotic surgery setting.
• RALS offers a viable surgical option with acceptable one-year morbidity across a broad spectrum of pediatric surgical procedures.