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Early and Long-term Complications of Robotic Assisted Laparoscopy in Infants and Children
Donatella Di Fabrizio1, Naved K Alizai1, Azad S Najmaldin1
1Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK.
Insights
Robotic-assisted laparoscopy in children shows low complication rates, even during technique development. Most complications were minor and occurred early, with severe cases presenting later.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Technology
Background:
- Robotic-assisted laparoscopy adoption remains limited in pediatric populations.
- This study details the largest single-institution experience with robotic surgery complications in infants and children over an 11-year period.
Purpose of the Study:
- To evaluate the safety and complication profile of robotic-assisted laparoscopy in pediatric patients.
- To report on the incidence, timing, and severity of complications in a large cohort.
Main Methods:
- A retrospective review of 601 consecutive robotic procedures performed on 539 infants and children between March 2006 and May 2017.
- Data collected included patient demographics, surgical details, and complication characteristics (timing, nature, and Clavien-Dindo grade).
Main Results:
- A total of 504 patients were analyzed, with an overall postoperative complication rate of 10.3%.
- 60 complications occurred in 57 patients (11.3%), with 3.2% classified as high-grade (Clavien-Dindo grade IIIa/b), including 1.4% requiring re-do surgery.
- No bleeding, grade IV/V complications, surgical mortality, or technology-related issues were reported. Most grade III complications occurred late.
Conclusions:
- Robotic-assisted laparoscopy in pediatric surgery is associated with low complication rates, even during the initial learning curve and technique refinement.
- The majority of complications were minor and occurred early postoperatively, while severe complications tended to manifest later.
Background:
Robotic-assisted laparoscopy still lacks wide acceptance in infants and children. We developed the service and report the largest single institution experience of complications over a period of 11 years.
Methods:
Between March 2006 and May 2017, consecutive infants and children who underwent robotic assisted laparoscopy under the care of two laparoscopic surgeons were studied. Data for patients, surgeons, year of surgery, operation, and timing, nature, grades of complications were assessed.
Results:
A total of 601 robotic procedures (45 different types) were carried out in 539 patients. Of these 31 (5.8%) were converted, none for operative complications. These and another 4 with complicated co-morbidity were excluded, leaving 504 patients for further analysis. There were 60 (11.9%) complications in 57 (11.3%) patients. Mean (SD) age was 7.7 years -/+5.1 with the youngest being 4 weeks. Concomitant or bilateral robotic and non-robotic procedures took place in 8.1% and 13.3% of patients respectively. Significant medical co-morbidity and abdominal scarring were present in 29% and 14.9% of patients respectively. Complications occurred in theatre 1.6%, hospital 5.6%, 28 days 1.2%, and late 3.6%. Mean follow up was 7.6 years -/+ 3.1 SD. Over-all postoperative complication rate was 10.3%: CD grade I 6.5% (33), II 0.6% (3), and IIIa/b 3.2% (16) which included 1.4% (7) re-do surgery. Most (11/16) grade III occurred late. There were no bleeding, grade IV or V complications, surgical mortality, or technology related complications.
Conclusions:
Complications are low even during the learning phase and while developing the new technique. Most complications occurred early and were minor. Most high-grade complications presented late.
Levels Of Evidence:
2B.
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