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Svetanoff WJ, Carter M, Diefenbach KA, Michalsky M, DaJusta D, Gong E, Lautz TB, Aldrink JH. Robotic-assisted Pediatric Thoracic and Abdominal Tumor Resection: An Initial Multi-center Review. J Pediatr Surg 2024; 59:1619-1625. [PMID: 38490885 DOI: 10.1016/j.jpedsurg.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Robotic-assisted minimally invasive surgery (RA-MIS) for tumor resection is an emerging technology in the pediatric population with significant promise but unproven safety and feasibility. METHODS A multi-center retrospective review of patients ≤18 years undergoing RA-MIS tumor resection from December 2015-March 2023 was performed. Patient demographics, perioperative variables, and complication rates were analyzed. RESULTS Thirty-nine procedures were performed on 38 patients (17 thoracic, 22 abdominal); 37% female and 68% non-Hispanic White. Median age at surgery was 8.3 years (IQR 5.7, 15.7); the youngest was 1.7 years-old. Thoracic operations included resections of neuroblastic tumors (n = 16) and a single paraganglioma. The most common abdominal operations included resections of neuroblastic tumors (n = 5), pheochromocytomas (n = 3), and angiomyolipomas (n = 3). Six patients underwent retroperitoneal lymph node dissection (RPLND) for paratesticular tumors. Median operating time for the cohort was 2:52 h (IQR 2:04, 4:31). Two thoracic cases required open conversion due to poor visualization and lack of working domain. All patients underwent complete tumor resection; one had tumor spillage from a positive margin (Wilms tumor). Median LOS was 1.5 days (IQR 1.1, 3.0). Postoperatively, one patient developed a chyle leak requiring interventional radiology drainage, but none required a return to the operating room. CONCLUSIONS Robotic-assisted surgery is safe and feasible for tumor resection in carefully selected pediatric patients, achieving complete resection with minimal morbidity and short LOS. Resection should be performed by those with robotic expertise for optimal outcomes. LEVEL OF EVIDENCE IV. TYPE OF STUDY Original Clinical Research.
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Affiliation(s)
- Wendy Jo Svetanoff
- Division of Pediatric Surgery, Nationwide Children's Hospital, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michela Carter
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA
| | - Karen A Diefenbach
- Division of Pediatric Surgery, Nationwide Children's Hospital, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Marc Michalsky
- Division of Pediatric Surgery, Nationwide Children's Hospital, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Daniel DaJusta
- Nationwide Children's Hospital, Department of Pediatric Urology, Columbus, OH, USA
| | - Edward Gong
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Timothy B Lautz
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Nationwide Children's Hospital, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
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Scoville SD, Bergus K, Diefenbach KA, Dajusta DG, Fuchs ME, Michalsky MP, Aldrink JH. Robotic-Assisted Surgery in Patients Less than 15 kg: A Single Center Review. J Laparoendosc Adv Surg Tech A 2024; 34:434-437. [PMID: 38294893 DOI: 10.1089/lap.2023.0178] [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: 02/02/2024] Open
Abstract
Introduction: Robotic-assisted surgery (RAS) is an increasingly utilized tool in children. However, utilization of RAS among infants and small children has not been well established. The purpose of this study was to review and characterize RAS procedures for children ≤15 kg. Methods: We performed a single institution retrospective descriptive analysis including all patients ≤15 kg undergoing RAS between January 2013 and July 2021. Data collection included procedure type, age, weight, gender, and surgical complications. Cases were further categorized according to surgical specialty: pediatric urology (PU), pediatric surgery (PS), and multiple specialties (MS). t-Tests were used for statistical analyses. Results: Since 2013, a total of 976 RAS were identified: 492 (50.4%) were performed by PU, 466 (47.8%) by PS, and 18 (1.8%) by MS. One hundred eighteen (12.1%) were performed on children ≤15 kg, consisting of 110 (93.2%) PU cases, 6 (5.1%) PS cases, and 2 (1.7%) MS cases. Procedures were significantly more common in the PU subgroup, mean of 12 cases/year, compared to PS subgroup, mean of 0.63 cases/year, (P < .01). The mean weight of PU patients (10.5 kg) was significantly less than PS patients (13.9 kg) (P < .01). Mean age was also significantly lower among PU patients (18.6 months) compared to PS (34.2 months) (P < .01). Conclusion: RAS among patients ≤15 kg is safe and feasible across pediatric surgical subspecialties. RAS was performed significantly more frequently by pediatric urologists in younger and smaller patients compared to pediatric surgeons. Further refinement of robotic technology and instrumentation should enhance the applicability of these procedures in this young group.
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Affiliation(s)
- Steven D Scoville
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
- Divisions of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Katherine Bergus
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Karen A Diefenbach
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
- Divisions of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Daniel G Dajusta
- Divisions of Urology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Molly E Fuchs
- Divisions of Urology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marc P Michalsky
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
- Divisions of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer H Aldrink
- Department of Surgery, Ohio State Wexner Medical Center, Columbus, Ohio, USA
- Divisions of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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Zeng Q, Chen C, Zhang N, Yu J, Yan D, Xu C, Liu D, Zhang Q, Zhang X. Robot-assisted thoracoscopic surgery for mediastinal tumours in children: a single-centre retrospective study of 149 patients. Eur J Cardiothorac Surg 2023; 64:ezad362. [PMID: 37897669 DOI: 10.1093/ejcts/ezad362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/28/2023] [Accepted: 10/27/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVES The purpose of this retrospective study was to summarize our experience in performing robot-assisted thoracoscopic surgery (RATS) for mediastinal tumours in children to investigate its safety and feasibility. METHODS This retrospective study involved 149 patients with mediastinal tumours who were hospitalized in the Department of Thoracic Surgery of Beijing Children's Hospital, Capital Medical University, and underwent RATS for tumour resection from March 2021 to November 2022. Information on patient age, weight, tumour size, surgical incision selection, operative time, intraoperative bleeding, intraoperative complications, length of hospital stay, rate of conversion to thoracotomy and follow-up conditions were summarized. RESULTS All 149 surgeries were successfully completed with no cases of mortality. There were 77 male and 72 female patients, with a mean age of 5.9 years (range: 6 months-16 years, 8 months) and a mean weight of 23.6 kg (8.0-72.0 kg). The mean maximum tumour diameter was 5.5 cm (2.0-12.0 cm), the mean operative time was 106.7 min (25.0-260.0 min), the mean intraoperative bleeding volume was 11.3 ml (1.0-400.0 ml) and the mean hospital stay was 7.2 days (4.0-14.0 days). All patients recovered well with no cases of tumour recurrence or mortality during the postoperative follow-up period (3-23 months). CONCLUSIONS RATS is safe and feasible to apply in children with mediastinal tumours who are >6 months of age and weigh more than 8 kg in terms of short-term outcomes, but longer-term follow-up is needed to fully evaluate the benefits. For cases that are associated with greater surgical difficulty and risk, a comprehensive surgical plan should be fully prepared in advance of surgery.
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Affiliation(s)
- Qi Zeng
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, Ministry of Science and Technology, Beijing, China
- Department of Paediatric Surgery, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Department of Thoracic Surgery, Beijing Engineering Research Center of Paediatric Surgery, Beijing, China
| | - Chenghao Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, Ministry of Science and Technology, Beijing, China
- Department of Paediatric Surgery, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Department of Thoracic Surgery, Beijing Engineering Research Center of Paediatric Surgery, Beijing, China
| | - Na Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, Ministry of Science and Technology, Beijing, China
- Department of Paediatric Surgery, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Department of Thoracic Surgery, Beijing Engineering Research Center of Paediatric Surgery, Beijing, China
| | - Jie Yu
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, Ministry of Science and Technology, Beijing, China
- Department of Paediatric Surgery, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Department of Thoracic Surgery, Beijing Engineering Research Center of Paediatric Surgery, Beijing, China
| | - Dong Yan
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, Ministry of Science and Technology, Beijing, China
- Department of Paediatric Surgery, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Department of Thoracic Surgery, Beijing Engineering Research Center of Paediatric Surgery, Beijing, China
| | - Changqi Xu
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, Ministry of Science and Technology, Beijing, China
- Department of Paediatric Surgery, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Department of Thoracic Surgery, Beijing Engineering Research Center of Paediatric Surgery, Beijing, China
| | - Dingyi Liu
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, Ministry of Science and Technology, Beijing, China
- Department of Paediatric Surgery, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Department of Thoracic Surgery, Beijing Engineering Research Center of Paediatric Surgery, Beijing, China
| | - Qian Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, Ministry of Science and Technology, Beijing, China
- Department of Paediatric Surgery, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Department of Thoracic Surgery, Beijing Engineering Research Center of Paediatric Surgery, Beijing, China
| | - Xu Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, Ministry of Science and Technology, Beijing, China
- Department of Paediatric Surgery, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
- Department of Thoracic Surgery, Beijing Engineering Research Center of Paediatric Surgery, Beijing, China
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Pu J, Li H, Liu Y, Hong M, Li S, Tang S. Robotic resection of paediatric solid tumours at a single institution. Int J Med Robot 2023; 19:e2495. [PMID: 36566355 DOI: 10.1002/rcs.2495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/27/2022] [Accepted: 12/22/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND To explore the clinical application of robotic-assisted surgery in paediatric solid tumours and to explore its feasibility. METHODS From 2015 to 2022, 53 children with solid tumours underwent robotic-assisted surgery in our centre were retrospectively analysed. RESULTS The mean weight of the patients was 27.7 kg, and the mean age was 6.7 years. The average tumour volume was 5.5*4.6*3.7 cm. Two procedures (3.8%) were converted. The mean total operative time was 198.5 min. The mean estimated blood loss was 27.1 ml, and no intraoperative complications occurred. Two (3.8%) patients had postoperative complications. At a median follow-up of 21.2 months, one (1.9%) patient with malignant tumours stopped treatment, and two (3.8%) patients developed tumour recurrence. CONCLUSIONS Robotic-assisted tumour resection is feasible in highly selected cases of young age, light weight, huge tumour or malignant tumour.
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Affiliation(s)
- Jiarui Pu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hang Li
- Department of Gastrointetinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Liu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mei Hong
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiwang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaotao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Şengül İnan M, Kavaklı K, Işık H, Sapmaz E, Gürkök S, İlhan Sezer E, Çaylak H, Genç O. Transthoracic robotic plication for diaphragmatic elevation. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:215-221. [PMID: 37484649 PMCID: PMC10357850 DOI: 10.5606/tgkdc.dergisi.2023.23283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/18/2022] [Indexed: 07/25/2023]
Abstract
Background This study aims to evaluate the feasibility, safety, and efficacy of transthoracic robot-assisted surgery for diaphragmatic plication and to describe our surgical approach in detail. Methods Between January 2014 and January 2020, a total of 13 patients (11 males, 2 females; median age: 55 years; range, 24 to 70 years) who underwent diaphragmatic plication with the robotic system were retrospectively analyzed. The changes in the Medical Research Council dyspnea scale, forced expiratory volume in 1 sec, body mass index, and quality of life scale scores of the patients before the operation and at the first year of follow-up were examined. Results Twelve of the operations were performed on the left side. The median pre- and postoperative Medical Research Council dyspnea scores were 2 (range, 1 to 4) and 1 (range, 1 to 4), respectively, indicating a statistically significant improvement (p=0.008). A significant improvement was detected in the forced expiratory volume in 1 sec of the patients in the first year after surgery (p=0.036). In terms of quality of life parameters, only, in the physical health subscale, the scores were statistically significantly different in the pre- and postoperative first-year follow-up (p=0.002). Median time to chest tube removal was 1 (range 1-5, IQR=0,5) days. Median total length of hospital stay was 2 (range 2-18, IQR=3) days. Conclusion Owing to its technical dexterity, the robot enables the plication to be performed easily and safely. Late improvement in respiratory functions is reflected in quality of life.
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Affiliation(s)
- Merve Şengül İnan
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Kuthan Kavaklı
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Hakan Işık
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Ersin Sapmaz
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Sedat Gürkök
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Elif İlhan Sezer
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Hasan Çaylak
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Onur Genç
- Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
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Huang D, Tang J, Wang F, Li L, Liang J, Zhuang L, Yang Q, Zeng J, Liu W. The feasibility and safety of same-day surgery for diaphragmatic eventration by minithoracotomy in children. Pediatr Surg Int 2021; 37:1215-1220. [PMID: 33864497 DOI: 10.1007/s00383-021-04907-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The diaphragmatic plication procedure by thoracoscopy has gradually become standard treatment for diaphragmatic eventration (DE). However, thoracoscopic diaphragmatic plication is difficult to manipulate and the surgical learning curve is long. This study aimed to demonstrate the feasibility and safety of same-day surgery for DE by minithoracotomy in children. METHODS From December 2017 to December 2019, we included 22 patients who underwent diaphragmatic plication of DE in the Department of Pediatric Thoracic Surgery at the Guangzhou Women and Children's Medical Center. A total of 10 patients underwent diaphragmatic plication by minithoracotomy and 12 patients underwent thoracoscopic plication. The perioperative condition and postoperative follow-up were evaluated, respectively. RESULTS The age, sex, and weight were no different in the minithoracotomy group versus the thoracoscopy group (P > 0.05). The intraoperative time, blood loss volume, and postoperative hospital stay of the minithoracotomy group were significantly less than that of the thoracoscopy group (31.10 ± 4.70 min vs. 72.08 ± 22.8 min; 1.20 ± 0.42 ml vs. 2.58 ± 1.67 ml; and 1.00 ± 0.00 days vs. 6.00 ± 2.95 days, respectively, all P < 0.05). The eventration levels in these two groups were significantly different in the perioperative and postoperative periods as detected by chest X-ray. No chest tubes were inserted and no recurrence of DE occurred in the thoracoscopy group through the postoperative follow-up of at least 6 months. CONCLUSION Same-day surgery by minithoracotomy as a treatment for DE was feasible and safe with less operative time, less blood loss, and low recurrence. Same-day surgery for DE was attributed to a quick recovery. More prospective studies are necessary to further explore the consequences of same-day surgery for DE by minithoracotomy.
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Affiliation(s)
- Dongmei Huang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Jue Tang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Fenghua Wang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Le Li
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Jianhua Liang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Linwei Zhuang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Qinglin Yang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Jiahang Zeng
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Wei Liu
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China.
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