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Robotic Surgery in Paediatric Oncology: Expanding Boundaries and Defining Relevant Indications
Thomas Blanc1, Kiarash Taghavi2, Mathilde Glenisson3
1Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France; Département « Croissance et Signalisation », Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université Paris Cité, Paris, France.
Insights
This review details the progress of a pediatric robotic surgery program, emphasizing safety and precision for improved oncological outcomes in children with selected tumors.
Area of Science:
- Pediatric Surgery
- Robotic Surgery
- Surgical Oncology
Background:
- Establishment of a Multidisciplinary Paediatric Robotic Program at Hôpital Necker-Enfants Malades.
- Focus on creating a safe and secure environment for patients and staff throughout the surgical process.
- Progressive increase in surgical confidence and case complexity within the program.
Purpose of the Study:
- To review the establishment and progress of a pediatric robotic surgery program.
- To present the guiding principles for robot-assisted surgery in pediatric tumors.
- To highlight the benefits of robotic surgery for achieving excellent oncological outcomes with minimally invasive approaches.
Main Methods:
- Systematic application of safety principles in a multidisciplinary pediatric robotic program.
- Utilizing robotic platforms for precision surgery, meticulous dissection, and complex tumor removal.
- Iterative increase in case complexity based on tumor characteristics, imaging, and surgical experience.
Main Results:
- Demonstrated increasing confidence and service expansion within the pediatric robotic surgery program.
- Successful application of robotic surgery for precision tumor removal with enhanced dissection capabilities.
- Achieved excellent oncological outcomes using minimally invasive robotic approaches in selected pediatric tumor cases.
Conclusions:
- Robot-assisted surgery, particularly image-guided, is the future of pediatric tumor surgery.
- A systematic, safety-focused approach enables successful and complex robotic procedures in children.
- The presented blueprint facilitates excellent oncological outcomes and minimally invasive treatment for pediatric endocrine, neuroblastic, and renal tumors.
Abstract:
This article reviews the establishment and progress of the Multidisciplinary Paediatric Robotic Program in a high-volume paediatric surgery department at Hôpital Necker-Enfants Malades, Paris, France. A major foundational principle of the program was to establish a safe and secure environment for patients and staff, both pre-operatively, intra-operatively and post-operatively. This founding principle when applied systematically has allowed increasing confidence across the program and service. The robotic platform allows for precision surgery when approaching tumours, with freedom of movement adapted to meticulous vascular and organ dissection. Surgical feasibility is based on tumour characteristics, pre-operative imaging, with a focus on vascular and organ involvement, considering goals of surgery and surgical experience. Case complexity has been gradually increased (where appropriate) through an iterative process. The future of surgery is robotic, and even more so image-guided surgery, and this synergy has been instrumental when approaching tumour surgery in children. The current principles that guide application of robot-assisted surgery in paediatric tumours are presented. With this blueprint, excellent oncological outcomes can be achieved while utilising a minimally invasive approach in children with selected endocrine, neuroblastic and renal tumours.
