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Exploring the frontier in robotic pediatric cancer surgery: when to move forward and when to stop
Federico Palo1, Stefano Avanzini1,2, Ida Barretta1,2
1Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Purpose:
In recent years, the use of robotic-assisted minimally invasive surgery in pediatric oncology has increased. Despite its benefits, its adoption remains limited. This single-center retrospective analysis examines technical nuances, indications, and surgical limitations to prevent complications.
Methods:
Data from cancer patients treated robotically in 2015-2016 (Group A) and 2020-2022 (Group B) were compared. Decision-making considered tumor characteristics and risks, guided by multidisciplinary tumor board discussions. Data collected included demographics, intra/post-operative details, and tumor classifications. Statistical analysis evaluated influencing factors.
Results:
Thirty-eight pediatric patients underwent robotic-assisted tumor resection, the median age was 5 years and weight 21.5 kg. Group A had higher median age and weight. Lesions included 23 malignant, 9 borderline, 5 benign cases; neuroblastoma (n = 19) was prevalent procedure and adrenalectomy was the predominant (28.94%). Open conversion occurred in 12 patients (31.58%), mainly due to vascular challenges (23.68%). Intraoperative complications were 10.53%, postoperative 7.9%. About 27% discharged by the third postoperative day; longer stays were needed for complex cases. All resumed post-op chemotherapy as scheduled, and all alive during follow-up.
Conclusions:
Our study confirms the safety and efficacy of robotic-assisted tumor resections in pediatric oncology, even during the learning phase, emphasizing the importance of learning curve, patient selection, and trocar positioning.
Insights
Robotic-assisted surgery is safe and effective for pediatric cancer tumor resection, even during initial learning phases. Careful patient selection and surgical technique are key to minimizing complications and ensuring positive outcomes.
Area of Science:
- Pediatric Oncology
- Surgical Robotics
- Minimally Invasive Surgery
Background:
- Robotic-assisted minimally invasive surgery (RAMIS) adoption in pediatric oncology is growing but faces limitations.
- Understanding technical nuances and limitations is crucial for safe and effective implementation.
Purpose of the Study:
- To examine technical nuances, indications, and surgical limitations of RAMIS in pediatric oncology.
- To identify factors influencing outcomes and prevent complications in robotic tumor resections.
Main Methods:
- Retrospective analysis of pediatric cancer patients treated with RAMIS between 2015-2016 and 2020-2022.
- Data included demographics, tumor characteristics, intra/post-operative details, and outcomes.
- Multidisciplinary tumor board discussions guided treatment decisions.
Main Results:
- 38 pediatric patients underwent robotic tumor resection; neuroblastoma was prevalent.
- Adrenalectomy was the most common procedure (28.94%).
- Open conversion occurred in 31.58% mainly due to vascular challenges; complication rates were low (intraoperative 10.53%, postoperative 7.9%).
Conclusions:
- Robotic-assisted tumor resections are safe and effective in pediatric oncology.
- The learning curve, patient selection, and trocar positioning are critical for successful outcomes.
- All patients resumed chemotherapy as scheduled and were alive at follow-up.
