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Arang H, El Boghdady M. Robotic Appendicectomy: A review of feasibility. Sultan Qaboos Univ Med J 2023; 23:440-446. [PMID: 38090254 PMCID: PMC10712383 DOI: 10.18295/squmj.7.2023.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/02/2023] [Accepted: 05/16/2023] [Indexed: 12/18/2023] Open
Abstract
Acute appendicitis is one of the most common abdominal emergencies. There has been an increasing use of robotic abdominal surgery. However, it remains underutilised in emergency settings. This study aimed to systematically review robotic appendicectomy (RA) feasibility. A 20-year systematic review was performed, along with quality assessment. The research protocol was registered with PROSPERO. The search yielded 1,242 citations, including 9 articles. The mean quality score was 10.72 ± 2.56. The endpoints across the studies were rate of conversion to open surgery, length of hospital stay, blood loss and operative time. RA is a safe, feasible technique that can be performed in elective and emergency settings with minimal blood loss. The operative time and hospital stay were within acceptable limits. Robotic surgery's major drawback is its high cost and limited availability. Future studies evaluating RA with a focus on its application during emergencies and its cost-effectiveness are recommended.
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Affiliation(s)
| | - Michael El Boghdady
- Department of General Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
- University of Edinburgh, Scotland, UK
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2
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Hey MT, Mayhew M, Masterson S, Calisto J, Shaffiey S, Malvezzi L, Alkhoury F. The safe introduction of robotic surgery in a free-standing children's hospital. J Robot Surg 2023; 17:2369-2374. [PMID: 37421569 DOI: 10.1007/s11701-023-01663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023]
Abstract
The aim of this study is to report the experience of implementing a pediatric robotic surgery program at a free-standing pediatric teaching hospital. A database was created to prospectively collect perioperative data for all robotic surgeries performed by the pediatric surgery department. The database was queried for all operations completed from October 2015 to December 2021. Descriptive statistics were used to characterize the dataset, using median and interquartile ranges for continuous variables. From October 2015 to December 2021, a total of 249 robotic surgeries were performed in the department of pediatric surgery. Of the 249 cases, 170 (68.3%) were female and 79 (31.7%) were male. Across all patients, there was a median weight (IQR) of 62.65 kg (48.2-76.68 kg) and a median (IQR) age of 16 years (13-18 years). The median (IQR) operative time was 104 min (79.0-138 min). The median console time was 54.0 min (33.0-76.0 min) and the median docking time was 7 min (5-11 min). The majority of procedures were performed on the biliary tree (52.6%). In the 249 procedures, there were no technical failures of the robot and only two operations (0.8%) were converted to open procedures and one (0.4%) to laparoscopic. This study highlights the ability to successfully integrate a pediatric robotic surgery program into a free-standing children's hospital with a low conversion rate. Additionally, the program extended across multiple surgical procedures and offered real-time exposure to advanced surgical techniques for current and aspiring pediatric surgery trainees.
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Affiliation(s)
- Matthew T Hey
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
| | - Mackenzie Mayhew
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
| | - Stephanie Masterson
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA
| | - Juan Calisto
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA
| | - Shahab Shaffiey
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA
| | - Leopoldo Malvezzi
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA
| | - Fuad Alkhoury
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA.
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3200 SW 60 Court #201, Miami, FL, 33155, USA.
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3
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Jacobson JC, Pandya SR. Pediatric robotic surgery: An overview. Semin Pediatr Surg 2023; 32:151255. [PMID: 36736161 DOI: 10.1016/j.sempedsurg.2023.151255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pediatric robotic surgery offers children a minimally invasive approach with numerous advantages over open or thoracoscopic and laparoscopic surgery. However, despite its widespread adoption for adult patients, the utilization of robotic surgery within pediatrics has been relatively slower to progress. This paper provides an overview of pediatric robotic surgery and discusses benefits, limitations, and strategies for successful implementation of robotics within pediatric surgical practice.
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Affiliation(s)
- Jillian C Jacobson
- Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX 75235, USA
| | - Samir R Pandya
- Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX 75235, USA.
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4
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Stern N, Li Y, Wang PZ, Dave S. A cumulative sum (CUSUM) analysis studying operative times and complications for a surgeon transitioning from laparoscopic to robot-assisted pediatric pyeloplasty: Defining proficiency and competency. J Pediatr Urol 2022; 18:822-829. [PMID: 36064506 DOI: 10.1016/j.jpurol.2022.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/16/2022] [Accepted: 07/24/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The transition from laparoscopic to robot-assisted procedures leads to potential increase in operative times and health care costs. Cumulative sum (CUSUM) analysis can objectively study the learning curve to detect significant changes in operative timing and monitor complication rates. OBJECTIVE The objective of this study is to investigate the total and step-specific times for pediatric robot-assisted pyeloplasty (RAP) to investigate the learning curve of a single surgeon transitioning from laparoscopic to RAP. STUDY DESIGN This prospective cohort study included 50 consecutive RAP procedures performed since the inception of our robotic program from June 2013 to January 2019. The CUSUM of RAP total operative time (OT) was calculated to determine the breakpoints between learning phases using piecewise linear regression. Cumulative-observed-minus-expected failure chart with 80% and 95% reassurance boundary lines was constructed using 5% acceptable and 10% unacceptable complication rates. Step-specific operative times were prospectively recorded by an independent observer for port placement, dissection and hitch stitch placement, pelvis dismemberment and spatulation, suturing and port removal. RESULTS Piecewise linear regression for OT identified breakpoints at case 13 and 29 suggesting transition at these points between Learning to Proficiency, and Proficiency to Competency. The overall mean OT was 142.2 ± 46.0 min. There was a significant difference in the mean OT between Learning (203.9 ± 35.3 min, the initial 13 cases), Proficiency (159.2 ± 18.6 min, the middle 16 cases), and Competency (126.6 ± 19.7 min, the last 21 cases) phases (p < 0.001). The complication rate for RAP stabilized around the acceptable level of 5% up to case 41 before finalizing at 8% overall. The step-specific analysis suggested that suturing entered the Competency phase at case 27, with a 50% decrease in suturing time from Learning to Proficiency and Competency. DISCUSSION Our study suggests that by case 30 a surgeon transitioning to RAP can achieve a significant decrease in OT. Complication rates remained within acceptable limits throughout, indicating that RAP can be safely adopted, even in low volume RAP centres. Suturing competency seems to be a significant advantage of the robotic platform as suggested by early significant decrease in suturing times noted between the Learning and Proficiency phases. CONCLUSION Future studies can confirm these findings and establish reference operative times to aid surgeons and trainees transitioning from laparoscopic pyeloplasty to RAP. Moreover, total OT decreases significantly and relatively soon after transition to RAP.
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Affiliation(s)
- Noah Stern
- Schulich School of Medicine and Dentistry: Western University Schulich School of Medicine & Dentistry, London ON, N6A 5C1, Canada.
| | - Yilong Li
- Schulich School of Medicine and Dentistry: Western University Schulich School of Medicine & Dentistry, London ON, N6A 5C1, Canada.
| | - Peter Zhantao Wang
- Schulich School of Medicine and Dentistry: Western University Schulich School of Medicine & Dentistry, Department of Surgery and Pediatrics, Division of Urology, London ON, N6A 5W9, Canada.
| | - Sumit Dave
- Schulich School of Medicine and Dentistry: Western University Schulich School of Medicine & Dentistry, Department of Surgery and Pediatrics, Division of Urology, London ON, N6A 5W9, Canada.
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Navarrete-Arellano M. Robotic-Assisted Minimally Invasive Surgery in Children. LATEST DEVELOPMENTS IN MEDICAL ROBOTICS SYSTEMS 2021. [DOI: 10.5772/intechopen.96684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Currently, minimally invasive surgery (MIS) includes conventional laparo-thoracoscopic surgery and robot-assisted surgery (RAS) or robotic surgery. Robotic surgery is performed with robotic devices, for example the Da Vinci system from Intuitive Surgical, which has a miniaturized camera capable of image magnification, a three-dimensional image of the surgical field, and the instruments are articulated with 7 degrees of freedom of movement, and the surgeon operates in a sitting position at a surgical console near the patient. Robotic surgery has gained an enormous surge in use on adults, but it has been slowly accepted for children, although it offers important advantages in complex surgeries. The areas of application of robotic surgery in the pediatric population include urological, general surgery, thoracic, oncological, and otorhinolaryngology, the largest application has been in urological surgery. There is evidence that robotic surgery in children is safe and it is important to offer its benefits. Intraoperative complications are rare, and the frequency of postoperative complications ranges from 0–15%. Recommendations for the implementation of a pediatric robotic surgery program are included. The future will be fascinating with upcoming advancements in robotic surgical systems, the use of artificial intelligence, and digital surgery.
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Krebs TF, Egberts JH, Lorenzen U, Krause MF, Reischig K, Meiksans R, Baastrup J, Meinzer A, Alkatout I, Cohrs G, Wieker H, Lüthje A, Vieten S, Schultheiss G, Bergholz R. Robotic infant surgery with 3 mm instruments: a study in piglets of less than 10 kg body weight. J Robot Surg 2021; 16:215-228. [PMID: 33772434 PMCID: PMC8863694 DOI: 10.1007/s11701-021-01229-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
No data exist concerning the appication of a new robotic system with 3 mm instruments (Senhance®, Transenterix) in infants and small children. Therefore, the aim of this study was to test the system for its feasibility, performance and safety of robotic pediatric abdominal and thoracic surgery in piglets simulating infants with a body weight lower than 10 kg. 34 procedures (from explorative laparoscopy to thoracoscopic esophageal repair) were performed in 12 piglets with a median age of 23 (interquartile range: 12–28) days and a median body weight of 6.9 (6.1–7.3) kg. The Senhance® robotic system was used with 3 mm instruments, a 10 mm 3D 0° or 30° videoscope and advanced energy devices, the setup consisted of the master console and three separate arms. The amount, size, and position of the applied ports, their distance as well as the distance between the three operator arms of the robot, external and internal collisions, and complications of the procedures were recorded and analyzed. We were able to perform all planned surgical procedures with 3 mm robotic instruments in piglets with a median body weight of less than 7 kg. We encountered two non-robot associated complications (bleeding from the inferior caval and hepatic vein) which led to termination of the live procedures. Technical limitations were the reaction time and speed of robotic camera movement with eye tracking, the excessive bending of the 3 mm instruments and intermittent need of re-calibration of the fulcrum point. Robotic newborn and infant surgery appears technically feasible with the Senhance® system. Software adjustments for camera movement and sensitivity of the fulcrum point calibration algorithm to adjust for the increased compliance of the abdominal wall of infants, therefore reducing the bending of the instruments, need to be implemented by the manufacturer as a result of our study. To further evaluate the Senhance® system, prospective trials comparing it to open, laparoscopic and other robotic systems are needed.
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Affiliation(s)
- Thomas F Krebs
- Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.,Department of Pediatric Surgery, Children's Hospital of East Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland
| | - Jan-Hendrik Egberts
- Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Ulf Lorenzen
- Department of Anesthesia and Intensive Care Medicine, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Martin F Krause
- Department of Pediatrics I and Pediatric Intensive Care Medicine, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Katja Reischig
- Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Roberts Meiksans
- Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Jonas Baastrup
- Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Andreas Meinzer
- Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Gesa Cohrs
- Department of Neurosurgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Henning Wieker
- Department of Cranio-Maxillo-Facial Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Annette Lüthje
- Department of Animal Welfare, CAU Kiel, Olshausenstr. 40, 24098, Kiel, Germany
| | - Sarah Vieten
- Department of Animal Welfare, CAU Kiel, Olshausenstr. 40, 24098, Kiel, Germany
| | - Gerhard Schultheiss
- Department of Animal Welfare, CAU Kiel, Olshausenstr. 40, 24098, Kiel, Germany
| | - Robert Bergholz
- Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
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7
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Moursi AGA, Grimminger P, Rohleder S, Muensterer O. [Robot-Assisted Repeated Fundoplication in Children and Adolescents]. Zentralbl Chir 2020; 145:509-512. [PMID: 32557430 DOI: 10.1055/a-1137-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recurrent gastroesophageal reflux symptoms in adolescents and young adults who underwent fundoplication in childhood present a technical challenge for the surgeon. The distal oesophagus and hiatus are difficult to access by laparotomy, the anatomy is modified by the primary procedure, and there are often dense adhesions between important structures. Robot-assisted surgery may be advantageous, because of the three dimensional (3D) view and the multiaxial freedom of movement afforded by the system. PURPOSE To describe our experience with robot-assisted Nissen re-fundoplication in adolescents who underwent primary fundoplication in childhood. METHODS The video shows the individual steps in robotic repeated fundoplication using the robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Three patients were operated with fundoplication at the age of 15 ± 2 years due to gastroesophageal reflux disease. After an average of 11,8 years after the primary procedure, they showed pathological reflux symptoms, which indicated repeated Nissen fundoplication. RESULTS AND DISCUSSION The 3D vision of the robotic system provided the surgeon with a good overview of the operative field. In addition, it allowed accurate dissection of the predictable adhesions around the hiatus. Mean operating time from incision to closure in the robot-assisted re-fundoplication was 174 min. Neither intra- nor postoperative complications occurred. As in conventional laparoscopic technique, there is a learning curve for the robotic surgery that can be appreciated from our data. Shorter dissection times and simplified dissection are potential benefits that need to be balanced with the higher cost of the robotic technique. CONCLUSION Robot-assisted re-fundoplication is an excellent alternative to the conventional laparoscopic procedure in young adults with recurrent gastroesophageal symptoms, who had a fundoplication in early childhood. The 3D-vision and the multi-axial free mobility of the instruments facilitate precise dissection that consider anatomic structures and adhesions.
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Affiliation(s)
| | - Peter Grimminger
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Deutschland
| | - Stephan Rohleder
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz, Deutschland
| | - Oliver Muensterer
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz, Deutschland
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Duza G, Davrieux CF, Palermo M, Khiangte E, Azfar M, Rizvi SAA, Trelles N, Zorraquin C, Sbai-Idrissi M, Le Brian Alban Z. Conventional Laparoscopic Appendectomy Versus Single-Port Laparoscopic Appendectomy, a Multicenter Randomized Control Trial: A Feasible and Safe Alternative to Standard Laparoscopy. J Laparoendosc Adv Surg Tech A 2019; 29:1577-1584. [PMID: 31613689 DOI: 10.1089/lap.2019.0460] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Acute appendicitis represents one of the main causes of surgical emergencies. It can be approached as open appendectomy or laparoscopic appendectomy (LA). LA uses different modalities, such as conventional laparoscopic appendectomy (CLA) or single-port laparoscopic appendectomy (SPLA). The aim of this work is to compare the results of CLA versus SPLA in patients diagnosed with Acute Appendicitis. Materials and Methods: A comparative multicenter prospective study of patients undergoing LA with a clinical diagnosis of acute appendicitis was presented. They were divided into two groups (CLA group and SPLA group). Results: A total of n = 147 patients were included (72 CLA and 75 SPLA). Preoperative and intraoperative times were shorter for patients undergoing CLA (P = .002; P = .068). Postoperative and reinsertion time was lower for SPLA (P = .000; P = .0004). There were no differences in postoperative complications. The type of approach showed statistically significant differences with respect to pain within the first 12 hours of the postoperative period, as well as at discharge, while no differences were observed in relation to cosmetic satisfaction when the two approaches were compared. Conclusion: SPLA technique presented less intraoperative time, shorter time of labor reinsertion, and less postoperative pain. There were no statistically significant differences in postoperative complications.
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Affiliation(s)
- Guillermo Duza
- Department of Surgery, Hospital Posadas, Buenos Aires, Argentina
| | - Carlos Federico Davrieux
- Department of Surgery, Sanatorio de la Mujer, Rosario, Argentina.,DAICIM Foundation, Buenos Aires, Argentina
| | - Mariano Palermo
- DAICIM Foundation, Buenos Aires, Argentina.,Diagnomed Center, Buenos Aires, Argentina
| | - Elbert Khiangte
- Department of Surgery, Patkijuli Christian Hospital, Patkijuli, India
| | - Mohamad Azfar
- Department of Surgery, Aligarh Hospital, Aligarh, India
| | | | - Nelson Trelles
- Department of Surgery, Poissy/Saint Germain Hospital, Poissy, France
| | - Carlos Zorraquin
- Department of Surgery, Hospital Posadas, Buenos Aires, Argentina
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Navarrete Arellano M, Garibay González F. Robot-Assisted Laparoscopic and Thoracoscopic Surgery: Prospective Series of 186 Pediatric Surgeries. Front Pediatr 2019; 7:200. [PMID: 31179254 PMCID: PMC6537604 DOI: 10.3389/fped.2019.00200] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/30/2019] [Indexed: 12/13/2022] Open
Abstract
Objective: We present the applications and experiences of robot-assisted laparoscopic and thoracoscopic surgery (RALTS) in pediatric surgery. Materials and Methods: A prospective, observational, and longitudinal study was conducted from March 2015 to March 2018 that involved a non-random sample of a pediatric population that was treated with RALTS. The parameters examined were: gender, age, weight, height, diagnoses, surgical technique, elapsed time of console surgery, estimated bleeding, need for hemotransfusion, complications, surgical conversions, postoperative hospital stay, and follow-up. The Clavien-Dindo classification of complications was used. The surgical system used was the da Vinci model, Si version (Intuitive Surgical, Inc., Sunnyvale, CA. U.S.A), with measures of central tendency. Results: In a 36-months period, 186 RALTS cases were performed, in 147 pediatric patients and an adult; 53.23% were male, and the remaining were female. The average age was 83 months, ranging from 3.5 to 204 months, plus one adult patient of 63 years. The stature was an average of 116.6 cm, with a range of 55-185 cm; the average weight was 26.9 kg, with a range of 5-102 kg; the smallest patient at 3.5 months was 55 cm in stature and weighed 5.5 kg. We performed 41 different surgical techniques, grouped in 4 areas: urological 91, gastrointestinal and hepatobiliary (GI-HB) 84, thoracic 6, and oncological 5. The console surgery time was 137.2 min on average, ranging from 10 to 780 min. Surgeon 1 performed 154 operations (82.8%), and the remainder were performed by Surgeon 2, with a conversion rate of 3.76%. The most commonly performed surgeries were: pyeloplasty, fundoplication, diaphragmatic plication, and removal of benign tumors, by area. Hemotransfusion was performed for 4.83%, and complications occurred in 2.68%. The average postoperative stay was 2.58 days, and the average follow-up was 23.5 months. The results of the 4 areas were analyzed in detail. Conclusion: RALTS is safe and effective in children. An enormous variety of surgeries can be safely performed, including complex hepatobiliary, and thoracic surgery in small children. There are few published prospective series describing RALTS in the pediatric population, and most only describe urological surgery. It is important to offer children the advantages and safety of minimal invasion with robotic assistance; however, this procedure has only been slowly accepted and utilized for children. It is possible to implement a robust program of pediatric robotic surgery where multiple procedures are performed.
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Affiliation(s)
| | - Francisco Garibay González
- Department of Pediatrics, Hospital Militar de Especialidades de la Mujer y Neonatología, SEDENA, Mexico City, Mexico
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10
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Moldes JM, de Badiola FI, Vagni RL, Mercado P, Tuchbaum V, Machado MG, López PJ. Pediatric Robotic Surgery in South America: Advantages and Difficulties in Program Implementation. Front Pediatr 2019; 7:94. [PMID: 30984719 PMCID: PMC6447650 DOI: 10.3389/fped.2019.00094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/04/2019] [Indexed: 11/21/2022] Open
Abstract
Robotic assisted laparoscopic surgery is gaining popularity around the world due to its vast benefits. Although it has been established mainly in developed countries, in South America the robotic programs have become more popular, but its growth is clearly slower. Information about robotic pediatric surgery program in Brazil, Chile, Uruguay, and Argentina was collected through e-mail surveys. Results were analyzed and compared to worldwide information about robotic surgery. Due to the wide social, economical, and technological gap between hospitals in South America, it is hard to develop a proper pediatric robotic surgery program. The main obstacles in those four countries appear to be a combination of high purchase costs and equipment maintenance, lack of financial coverage of the procedure by insurance companies and the absence of significant benefits proved in pediatrics in relation to laparoscopic surgery. The pediatric specialties are in the process of making and implementing robotic programs supported by the evident development in adult specialties. However, pediatric robotic surgery in Brazil, Chile, Uruguay and Argentina do not seems to share that growth.
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Affiliation(s)
- Juan M Moldes
- Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Roberto Luis Vagni
- Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pedro Mercado
- Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Virginia Tuchbaum
- Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcos G Machado
- Department of Urology, Faculdade de Medicina, Universidade de São Paulo, Hospital das Clínicas, São Paulo, Brazil
| | - Pedro José López
- Department Pediatric Urology, Hospital Exequiel Gonzalez Cortés y Clínica Alemana, Santiago, Chile
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11
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Marcadis AR, Romain CV, Alkhoury F. Robotic duodeno-duodenostomy creation in a pediatric patient with idiopathic duodenal stricture. J Robot Surg 2018; 13:695-698. [PMID: 30406381 DOI: 10.1007/s11701-018-0891-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
Duodenal stenosis is one of the leading causes of duodenal obstruction in the pediatric population, usually diagnosed in newborns and in Down syndrome patients. It has historically been treated with duodeno-duodenostomy, an operation that is now commonly performed laparoscopically. We present a case of a 10-year-old child with a rare chromosomal abnormality who was diagnosed with a duodenal stricture after presenting with failure to thrive and inability to tolerate tube feeds. Duodeno-duodenostomy was performed using the da Vinci® robot, allowing for improved intra-operative range of motion and control during anastomosis creation, with the same cosmetic benefits of laparoscopic surgery, and subsequent improvement in symptoms postoperatively. This case highlights the utility of robotic surgery in complex operations in the pediatric population.
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Affiliation(s)
- Andrea R Marcadis
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA.
| | - Carmelle V Romain
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
| | - Fuad Alkhoury
- Department of Pediatric Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
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12
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Murthy PB, Schadler ED, Orvieto M, Zagaja G, Shalhav AL, Gundeti MS. Setting up a pediatric robotic urology program: A USA institution experience. Int J Urol 2017; 25:86-93. [DOI: 10.1111/iju.13415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/07/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Prithvi B Murthy
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Eric D Schadler
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Marcelo Orvieto
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Gregory Zagaja
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Arieh L Shalhav
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
| | - Mohan S Gundeti
- Section of Urology; Comer Children's Hospital; The University of Chicago Medicine and Biological Sciences; Chicago Illinois USA
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