In a recent review article published in the Journal of Pediatric Surgery, researchers explored the current state of robotic surgery in pediatric general surgery, highlighting its benefits, limitations, and strategies to overcome these challenges. They also discussed future prospects with new technologies and platforms.
Study: Pedi-Bots: Innovations and progress in robotic pediatric general surgery. Image Credit: Gorodenkoff/Shutterstock.com
Background
Robotic surgery was introduced in the late 1990s, with the Da Vinci Surgical System (DVSS) being the first commercially available system. Since then, robotic surgery has become significant in adult surgical fields like urology, gynecology, and colorectal surgery.
This field offers many advantages over traditional surgery, such as improved visualization, precision, ergonomics, and outcomes. However, in pediatric surgery, robotic surgery is still rare due to the size of the instruments, limited working space, high costs, the learning curve, and the large size of robot arms compared to small patients.
The DVSS provides instruments in 5 mm or 8 mm and an endoscopic camera in 8.5 mm or 12 mm sizes, which can be too large for some pediatric procedures. Additionally, robot arms may collide with each other or the table edge, limiting their motion and access.
Other challenges include the system's cost, maintenance, availability, scheduling, and the training and certification of surgeons and staff. There is also a lack of evidence on robotic surgery's long-term outcomes and cost-effectiveness in children.
About the Review
In this study, the authors conducted a comprehensive literature review on the use, safety, and outcomes of robotic surgery in pediatric general surgery, with a focus on abdominal and thoracic procedures.
They searched PubMed, Embase, and Cochrane databases for articles published between 2000 and 2020 using relevant keywords. Studies on robotic surgery in children for gastrointestinal, hepatobiliary, or thoracic procedures were included, while urological, gynecological, and cardiac procedures were excluded.
Data were extracted on procedure types, patient characteristics, operative details, complications, conversions, length of stay, postoperative pain, and recovery time. The review also covered current and emerging robotic platforms and technologies, comparing the advantages and disadvantages of robotic surgery with laparoscopic or open surgery.
Findings
The researchers identified 2,392 pediatric robotic procedures reported in the literature, including 31 types of gastrointestinal procedures, 25 genitourinary procedures, and 12 thoracic procedures.
The most common procedures were pyeloplasty, Nissen fundoplication, cholecystectomy, and mediastinal mass resection. They found that robotic surgery was feasible and safe in children, with outcomes comparable to or better than laparoscopic or open surgery in terms of complications, conversion rates, blood loss, hospital stay, pain, and recovery time.
Robotic surgery offered improved visualization, precision, dexterity, and ergonomics, facilitating access and manipulation in challenging anatomical areas. It also benefited minimally invasive surgery with reduced blood loss, postoperative pain, narcotic use, smaller incisions, shorter hospital stays, and faster recovery. The conversion rate from robotic to open surgery was low, ranging from 4.2% to 10% depending on the age group, with rare and minor complications.
Furthermore, the authors discussed strategies to overcome size limitations in pediatric robotic surgery, such as patient positioning, port placement optimization, using smaller instruments and endoscopes, and employing a laparoscopic assistant.
They highlighted emerging robotic platforms like the Senhance Surgical System (Asensus Surgical, Morrisville, NC), which offers 3 mm instruments and haptic feedback, and the Hugo RASS (Medtronic, Dublin, Ireland), with modular and independent robot arms.
Applications
Robotic surgery has the potential to improve pediatric surgery quality and outcomes, especially for complex procedures requiring high precision and dexterity. It may also enhance surgeon performance and comfort, reducing fatigue and musculoskeletal injuries.
Additionally, robotic surgery could increase the availability and accessibility of pediatric surgery, especially in remote or underserved areas, through tele-surgery or telementoring. It may also aid in the training and education of pediatric surgeons by providing simulation, feedback, and assessment tools.
Conclusion
The review summarized that robotic surgery is a promising and evolving field in pediatric general surgery, offering many advantages over traditional methods. However, challenges such as instrument size, cost, and the learning curve still limit its use in children.
The authors suggested that further research and innovation are needed to develop pediatric-specific robotic platforms and instruments and evaluate the long-term outcomes and cost-effectiveness of robotic surgery in children.
They recommended that pediatric surgeons embrace robotic surgery as a valuable tool for improving their practice and providing better care for their patients.
Journal Reference
Sutyak, K, M., & Tsao, K. Pedi-Bots: Innovations and progress in robotic pediatric general surgery. Journal of Pediatric Surgery Open, 2024, 7, 100156. DOI: 10.1016/j.yjpso.2024.100156. https://www.sciencedirect.com/science/article/pii/S2949711624000418
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