Paediatric robotic surgery: a narrative review

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Abstract

The benefits of minimally invasive surgery (MIS) compared with traditional open surgery, including reduced postoperative pain and a reduced length of stay, are well recognised. A significant barrier for MIS in paediatric populations has been the technical challenge posed by laparoscopic surgery in small working spaces, where rigid instruments and restrictive working angles act as barriers to safe dissection. Thus, open surgery remains commonplace in paediatrics, particularly for complex major surgery and for surgical oncology. Robotic surgical platforms have been designed to overcome the limitations of laparoscopic surgery by offering a stable 3-dimensional view, improved ergonomics and greater range of motion. Such advantages may be particularly beneficial in paediatric surgery by empowering the surgeon to perform MIS in the smaller working spaces found in children, particularly in cases that may demand intracorporeal suturing and anastomosis. However, some reservations have been raised regarding the utilisation of robotic platforms in children, including elevated cost, an increased operative time and a lack of dedicated paediatric equipment. This article aims to review the current role of robotics within the field of paediatric surgery.

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Most cited references 95

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Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials.

Esther Kuhry, Wolfgang Schwenk, Robin Gaupset … (2008)

The aim of this systematic review is to evaluate long-term outcome of laparoscopically assisted versus open surgery for non-metastasised colorectal cancer. Cochrane library, EMBASE, Pub med and CancerLit were searched for published and unpublished randomised controlled trials. RevMan 4.2 was used for statistical analysis. Twelve trials (3346 patients) reported long-term outcome and were included in the current analyses. No significant differences were found between laparoscopic and open surgery in the occurrence of incisional hernias or the number of reoperations for adhesions (p=0.32 and 0.30, respectively). Port-site metastases and wound recurrences were rare and no differences in occurrence after laparoscopic and open surgery were observed (p=0.16). Cancer-related mortality at maximum follow-up was similar after laparoscopic and open surgery (p=0.15 and 0.16 for colon and rectal cancer, respectively). No significant difference in tumour recurrence after laparoscopic and open surgery for colon cancer was observed (3 RCTs, hazard ratio for tumour recurrence in the laparoscopic group 0.86; 95% CI 0.70-1.08). In colon cancer patients, no significant differences in overall mortality were found (2 RCTs, hazard ratio for overall mortality after laparoscopic surgery 0.86; 95% CI 0.86-1.07). Laparoscopic resection of carcinoma of the colon is associated with a long-term outcome that is similar to that after open colectomy. Laparoscopic surgery for cancer of the upper rectum is feasible, but more randomised trials need to be conducted to assess long-term outcome.

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S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer.

J. Park, Tony K H Lim, Myung-Gyu Choi … (2010)

In recent years, robot-assisted surgery using the da Vinci System® has been proposed as an alternative to traditional open or laparoscopic procedures. The aim of this study was to compare the short-term outcomes for open, laparoscopic, and robot-assisted rectal resection for cancer. Two hundred sixty-three patients with rectal cancer who underwent curative resection between 2007 and 2009 were included. Patients were classified into an open surgery group (OS, n = 88), a laparoscopic surgery group (LAP, n = 123), and a robot-assisted group (RAP, n = 52). Data analyzed include operating time, length of recovery, methods of specimen extraction, quality of total mesorectal excision, and morbidity. The mean operating time was 233.8 ± 59.2 min for the OS group, 158.1 ± 49.2 min for the LAP group, and 232.6 ± 52.4 min for the RAP group (p < 0.001). Patients from the LAP and RAP groups recovered significantly faster than did those from the OS group (p < 0.05). The proportion of operations performed through a natural orifice (intracorporeal anastomosis with transanal or transvaginal retrieval of specimens) was significantly higher in the RAP group (p < 0.001). The specimen quality--with a distal resection margin, harvested lymph nodes, and circumferential margin--did not differ among the three groups. The overall complication rates were 20.5, 12.2, and 19.2% in the OS, LAP, and RAP groups, respectively (p = 0.229). RAP and LAP reproduce the equivalent short-term results of standard OS while providing the advantages of minimal access. For the experienced laparoscopic colorectal oncologist, use of the da Vinci robot resulted in no significant short-term clinical benefit over the conventional laparoscopic approach.

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Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results.

Juana M. Flores, Valerie Rusch, Jungsun Park (2005)

There is little experience with telerobotic assistance for video-assisted thoracic surgical lobectomy. We developed a technique for robotic assistance during video-assisted thoracic surgical lobectomy and report our initial results. Video-assisted thoracic surgical lobectomy with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, Calif) was attempted in 34 patients (median age, 69.0 years; age range, 12-85 years). Robotic instruments were used for individual dissection of the hilar structures through 2 thoracoscopic ports and a 4-cm utility incision without rib spreading. Data on patient characteristics and perioperative results were collected prospectively. Robot-assisted video-assisted thoracic surgical lobectomy was accomplished in 30 patients (19 female and 11 male patients). Every type of lobectomy was performed. Four (4/34 [12%]) patients required conversion to thoracotomy. The majority of patients had non-small cell lung cancer (32/34 [94%]), and 1 patient each had a typical carcinoid tumor and an extranodal B-cell lymphoma. Every patient underwent an R0 resection. The median number of lymph node stations dissected with robotic assistance was 4 (range, 2-7). Operative mortality was 0%, with no in-hospital or perioperative deaths. Nine (26%) patients experienced National Cancer Institute Common Toxicity Criteria for Adverse Events version 3.0 grade 2 or 3 complications. The median chest tube duration was 3.0 days (range, 2-12 days), and the median length of stay was 4.5 days (range, 2-14 days). The median operative time was 218 minutes (range, 155-350 minutes). Robot assistance for video-assisted thoracic surgical lobectomy is feasible and safe. The utility and advantages of robotic assistance for video-assisted thoracic surgical lobectomy require further refinement and study of the technique.

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Author and article information

Contributors

Enda Hannan: endahannan@rcsi.com

Journal

Journal ID (nlm-ta): J Robot Surg

Journal ID (iso-abbrev): J Robot Surg

Title: Journal of Robotic Surgery

Publisher: Springer London (London )

ISSN (Print): 1863-2483

ISSN (Electronic): 1863-2491

Publication date (Electronic): 16 January 2023

Publication date PMC-release: 16 January 2023

Publication date (Print): 2023

Volume: 17

Issue: 4

Pages: 1171-1179

Affiliations

[1 ]GRID grid.417322.1, ISNI 0000 0004 0516 3853, Department of Paediatric Surgery, , Children’s Health Ireland at Crumlin, ; Dublin, Ireland

[2 ]GRID grid.415522.5, ISNI 0000 0004 0617 6840, Department of Colorectal Surgery, , University Hospital Limerick, ; St Nessan’s Road, Dooradoyle, Limerick, Co Limerick Ireland

[3 ]GRID grid.10049.3c, ISNI 0000 0004 1936 9692, School of Medicine, , University of Limerick, ; Limerick, Ireland

Article

Publisher ID: 1523

DOI: 10.1007/s11701-023-01523-z

PMC ID: 10374698

PubMed ID: 36645643

SO-VID: 614b761e-8d1a-43f4-b4f2-ddf0393b1cc1

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 11 July 2022

Date accepted : 2 January 2023

Funding

Funded by: Royal College of Surgeons in Ireland (RCSI)

Open Access :

Open Access funding provided by the IReL Consortium

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ScienceOpen disciplines: Surgery

Keywords: paediatric robotic surgery,paediatric surgery,robotic surgery,minimally invasive surgery

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ScienceOpen disciplines: Surgery

Keywords: paediatric robotic surgery, paediatric surgery, robotic surgery, minimally invasive surgery

Paediatric robotic surgery: a narrative review

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Most cited references 95

Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials.

S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer.

Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results.

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