Safety and feasibility of robot-assisted laparoscopic telesurgery in pediatric surgery: a case series

Despite an escalating number of robot models that have facilitated remote surgery since 2008, the utilization of robotic remote surgery in pediatric surgery remains unreported. This study aims to evaluate the feasibility of applying the single-port robotic system (SHURUI SR-ENS-600) in pediatric robot-assisted laparoscopic remote surgery.

Between October 2024 and February 2025, an experienced surgeon situated at tertiary medical centers in Guangzhou and Liuzhou employed the SHURUI Endoscopic Surgical Robotic System to perform remote robot-assisted laparoscopic appendectomy (RA) and robot-assisted laparoscopic choledochal cyst excision (RC) in four pediatric patients. Patients meeting the enrollment criteria underwent robot-assisted laparoscopic telesurgery (RLT) using SHURUI system. Trained assistants were positioned on the patients' side to avoid possible complications. Two cases of RA and two of RC were conducted, involving one male and three females, with a median age of 7 years (range, 4-11 years). All procedures were completed using telesurgery alone, and no conversions were recorded. The surgeon and the patient were separated by a distance of 512 km, with a mean round-trip latency of 28.50 ms (range, 25-33 ms). The median total operative time was 266 min (range, 90-481 min), and the median remote control duration was 171 min (range, 55-308 min). There were no complications nor mortalities observed in the perioperative period. All patients were routinely followed up without loss and the median follow-up time was 3.5 months (range, 2-6 months).

The results suggest that RLT is practicable and secure under the supervision of an experienced surgery team. Further research with larger sample sizes is necessary to explore the application of RLT in pediatric surgery.