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Assessment of robotic surgery in small children

Quentin Ballouhey, Véronique Carcauzon-Couvrat, Daniel Bérenguer, Sophiane Derbal, Marion Beurdeley, Asma Grimaudo, Bernard Longis, Laurent Fourcade

Department of Pediatric Surgery, Limoges, France



Aim: robotic assisted minimal invasive surgery (RMIS) is broadly accepted as a new option by adult surgical community. It is actually assessed as a new technology in children. Its feasibility and benefits are still debated by pediatric surgeons. Initial results for pediatric urology are encouraging. Few manuscripts mention the application of RMIS for small children. Our aim was to compare surgical results for patients less than 15 kg with others patients regarding feasibility, safety and limitations.
Methods: we retrospectively reviewed our first 64 consecutive cases over a 5-year period between January 2007 and December 2012 in our surgical pediatric center, including thoracic, gastro-intestinal and urology procedures. Group A (weight less than 15.0 kg) was compared to group B (weight more than 15.0 kg) with a special focus on surgical feasibility, total operative time, procedure completion rate and postoperative course.
Results: group A (28 patients, 10.9 kg) was compared to group B (34 patients, 27.0 kg). The overall procedure completion rate was 94 %, three patients with thoracic procedures from group A were converted to open procedures and one patient from group B to standard laparoscopic mini invasive surgery for ureteric re-implantation because of a camera failure. Mean operative time was respectively for group A and B 191 minutes (range 75-330) and 173 minutes (range 70-390). Postoperative follow-up offered similar results for both groups. Reoperations were required for two and three patients for group A and B respectively.
Conclusion: these data support the safety and feasibility for RMIS in small children. Limitations still exist particularly for thoracoscopic procedures and children less than 5 kg. Advances in smaller instruments should permit the widespread use of such technology for neonatal surgery.