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Palo F, Avanzini S, Barretta I, Monti M, Torre M, Conte M, Calevo MG, Mattioli G. Exploring the frontier in robotic pediatric cancer surgery: when to move forward and when to stop. Pediatr Surg Int 2024; 40:140. [PMID: 38806812 DOI: 10.1007/s00383-024-05726-9] [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] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE In recent years, the use of robotic-assisted minimally invasive surgery in pediatric oncology has increased. Despite its benefits, its adoption remains limited. This single-center retrospective analysis examines technical nuances, indications, and surgical limitations to prevent complications. METHODS Data from cancer patients treated robotically in 2015-2016 (Group A) and 2020-2022 (Group B) were compared. Decision-making considered tumor characteristics and risks, guided by multidisciplinary tumor board discussions. Data collected included demographics, intra/post-operative details, and tumor classifications. Statistical analysis evaluated influencing factors. RESULTS Thirty-eight pediatric patients underwent robotic-assisted tumor resection, the median age was 5 years and weight 21.5 kg. Group A had higher median age and weight. Lesions included 23 malignant, 9 borderline, 5 benign cases; neuroblastoma (n = 19) was prevalent procedure and adrenalectomy was the predominant (28.94%). Open conversion occurred in 12 patients (31.58%), mainly due to vascular challenges (23.68%). Intraoperative complications were 10.53%, postoperative 7.9%. About 27% discharged by the third postoperative day; longer stays were needed for complex cases. All resumed post-op chemotherapy as scheduled, and all alive during follow-up. CONCLUSIONS Our study confirms the safety and efficacy of robotic-assisted tumor resections in pediatric oncology, even during the learning phase, emphasizing the importance of learning curve, patient selection, and trocar positioning.
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Affiliation(s)
- Federico Palo
- Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Avanzini
- Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- University of Genoa, DINOGMI, Genoa, Italy
| | - Ida Barretta
- Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- University of Genoa, DINOGMI, Genoa, Italy
| | - Martina Monti
- Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
- University of Genoa, DINOGMI, Genoa, Italy.
| | - Michele Torre
- Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- University of Genoa, DINOGMI, Genoa, Italy
| | - Massimo Conte
- Pediatric Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- University of Genoa, DINOGMI, Genoa, Italy
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Ram C, Pitt JB, Wallace MW, Goldstein SD, Zamora IJ. Framework for pediatric robotic surgery program development. Semin Pediatr Surg 2024; 33:151389. [PMID: 38245993 DOI: 10.1016/j.sempedsurg.2024.151389] [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: 01/23/2024]
Abstract
Pediatric robotic surgery has seen increasing implementation for its many benefits over the past two decades. As more pediatric surgeons gain exposure to robotic surgery, the interest in utilizing this technology is growing. However, there are no guidelines or existing framework for developing pediatric general surgery robotic programs. Programmatic development can be challenging, requiring institutional support, a minimum 12-month multistep process in partnership with the robot manufacturer, and organization of a local dedicated team. A cornerstone to all program building is collaboration and communication with key stakeholders who are committed to establishing a robotic surgery program. In this manuscript, we detail numerous best practices for implementation, followed by three variations of programmatic development, each drawing lessons from one of three practice settings: (i) A children's hospital in a large medical center associated with an adult hospital, (ii) a free-standing children's hospital, and (iii) a community-based practice. We aim for this article to provide a framework that can serve as a guide for those beginning this process, consolidating the key resources and strategies used to develop a robust pediatric robotic surgery program.
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Affiliation(s)
- Chirag Ram
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - J Benjamin Pitt
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Irving J Zamora
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
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Valls-Esteve A, Adell-Gómez N, Pasten A, Barber I, Munuera J, Krauel L. Exploring the Potential of Three-Dimensional Imaging, Printing, and Modeling in Pediatric Surgical Oncology: A New Era of Precision Surgery. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050832. [PMID: 37238380 DOI: 10.3390/children10050832] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Pediatric surgical oncology is a technically challenging field that relies on CT and MRI as the primary imaging tools for surgical planning. However, recent advances in 3D reconstructions, including Cinematic Rendering, Volume Rendering, 3D modeling, Virtual Reality, Augmented Reality, and 3D printing, are increasingly being used to plan complex cases bringing new insights into pediatric tumors to guide therapeutic decisions and prognosis in different pediatric surgical oncology areas and locations including thoracic, brain, urology, and abdominal surgery. Despite this, challenges to their adoption remain, especially in soft tissue-based specialties such as pediatric surgical oncology. This work explores the main innovative imaging reconstruction techniques, 3D modeling technologies (CAD, VR, AR), and 3D printing applications through the analysis of three real cases of the most common and surgically challenging pediatric tumors: abdominal neuroblastoma, thoracic inlet neuroblastoma, and a bilateral Wilms tumor candidate for nephron-sparing surgery. The results demonstrate that these new imaging and modeling techniques offer a promising alternative for planning complex pediatric oncological cases. A comprehensive analysis of the advantages and limitations of each technique has been carried out to assist in choosing the optimal approach.
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Affiliation(s)
- Arnau Valls-Esteve
- Innovation Department, SJD Barcelona Children's Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- 3D for Health Unit (3D4H), SJD Barcelona Children's Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Núria Adell-Gómez
- Innovation Department, SJD Barcelona Children's Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- 3D for Health Unit (3D4H), SJD Barcelona Children's Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Albert Pasten
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, SJD Barcelona Children's Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Ignasi Barber
- Department of Diagnostic Imaging, SJD Barcelona Children's Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Josep Munuera
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- 3D for Health Unit (3D4H), SJD Barcelona Children's Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Department of Diagnostic Imaging, SJD Barcelona Children's Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Lucas Krauel
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- 3D for Health Unit (3D4H), SJD Barcelona Children's Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, SJD Barcelona Children's Hospital, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
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