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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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2
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O'Brien LP, Hannan E, Antao B, Peirce C. Paediatric robotic surgery: a narrative review. J Robot Surg 2023; 17:1171-1179. [PMID: 36645643 PMCID: PMC10374698 DOI: 10.1007/s11701-023-01523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/02/2023] [Indexed: 01/17/2023]
Abstract
The benefits of minimally invasive surgery (MIS) compared with traditional open surgery, including reduced postoperative pain and a reduced length of stay, are well recognised. A significant barrier for MIS in paediatric populations has been the technical challenge posed by laparoscopic surgery in small working spaces, where rigid instruments and restrictive working angles act as barriers to safe dissection. Thus, open surgery remains commonplace in paediatrics, particularly for complex major surgery and for surgical oncology. Robotic surgical platforms have been designed to overcome the limitations of laparoscopic surgery by offering a stable 3-dimensional view, improved ergonomics and greater range of motion. Such advantages may be particularly beneficial in paediatric surgery by empowering the surgeon to perform MIS in the smaller working spaces found in children, particularly in cases that may demand intracorporeal suturing and anastomosis. However, some reservations have been raised regarding the utilisation of robotic platforms in children, including elevated cost, an increased operative time and a lack of dedicated paediatric equipment. This article aims to review the current role of robotics within the field of paediatric surgery.
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Affiliation(s)
- Lukas Padraig O'Brien
- Department of Paediatric Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Enda Hannan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Co Limerick, Ireland.
| | - Brice Antao
- Department of Paediatric Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Co Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
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Shen LT, Tou J. Application and prospects of robotic surgery in children: a scoping review. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000482. [PMID: 36474741 PMCID: PMC9717356 DOI: 10.1136/wjps-2022-000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
As an innovative minimally invasive surgical technology, robot-assisted surgery (RAS) has greatly improved the accuracy and safety of surgery through the advantages of three-dimensional magnification, tremor filtering, precision and flexibility, and has been carried out by an increasing number of surgeries. In recent years, robots have been gradually applied to children, bringing new ideas and challenges to pediatric surgeons. This review will describe the advantages and limitations of robotic surgery in children, summarize its application in pediatric surgery, and provide an outlook. It is believed that clinicians should actively carry out RAS under the premise of rigorously ensuring surgical indications and strive to improve the efficacy of surgical treatment for children.
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Affiliation(s)
- Lei Ting Shen
- Neonatal Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinfa Tou
- Neonatal Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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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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Vatta F, Gazzaneo M, Bertozzi M, Raffaele A, Avolio L, Riccipetitoni G. Robotics-Assisted Pediatric Oncology Surgery-A Preliminary Single-Center Report and a Systematic Review of Published Studies. Front Pediatr 2021; 9:780830. [PMID: 35118030 PMCID: PMC8805994 DOI: 10.3389/fped.2021.780830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
AIM The use of robotics-assisted surgery in oncology has been proved effective and safe in adults. Despite these results, the use of robotics has been rarely reported for pediatric oncology. Our review aims to evaluate the safety and feasibility of robotics-assisted surgery in this field, analyzing our experience and performing a systematic review of the most recent studies. METHODS We reviewed all patients affected by an oncological disease who underwent a robotics-assisted procedure at our institute. We performed a systematic review of the literature from 2012 to 2021 on the subjects. FINDINGS A total of 14 patients underwent robotics-assisted tumor resection. Eleven procedures (median age 13.2-years old) were carried out in children with adnexal lesions (seven tumor excision and four ovariectomies). Histological diagnosis was mature teratoma (six), serous papillary cystadenofibromas of the fallopian tube (two), ovarian serous cystadenoma (one), ovarian mucinous cystadenoma (one), and ovarian seromucinous cystadenoma. The median length of stay was 2 days. No recurrences or complications at a median follow-up of 2.1-years were observed. A 5-year-old girl underwent a complete posterior resection of a type 3 sacrococcygeal tumor with a robotics-assisted approach for the dissection of a possible intraabdominal residual component of the lesion. No intra- and postoperative complications were recorded. Complete excision of a recurrent differentiating neuroblastoma of the left para-renal region was performed on a 9-year-old girl. An idiopathic anaphylactic shock occurred 1 day after the procedure. At 9 months' follow-up, no local recurrences of the lesion were observed. Overall, we reported no conversion to open surgery. Lastly, a robotic excision of a growing left superior mediastinal intermixed ganglioneuroblastoma was performed on an 8-year-old girl with no postoperative complications. Follow-up was uneventful (7 months). In the literature, the rate of complications ranges from 0 to 28%, mainly related to difficult dissection and impaired anatomy. Conversion is reported in 5% of all oncological procedures, due to more invading tumors and altered anatomical features. No robotics-related complications were reported. CONCLUSION Robotics-assisted surgery in pediatric oncology has proven to be feasible. Nevertheless, its use should be limited to selected cases and performed by highly trained oncological surgeons. Preparation and patient positioning, alongside a correct port placement, are crucial to carrying out these procedures. Further innovations in robotics may allow a wider application of this technology in pediatric oncology.
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Affiliation(s)
- Fabrizio Vatta
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Gazzaneo
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mirko Bertozzi
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Raffaele
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigi Avolio
- Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Sinha A, Pathak M, Vig A, Saxena R. Robotic surgery in paediatric patients: Our initial experience and roadmap for successful implementation of robotic surgery programme. J Minim Access Surg 2021; 17:32-36. [PMID: 31670291 PMCID: PMC7945638 DOI: 10.4103/jmas.jmas_174_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction: The popularity of robot-assisted surgeries has accelerated since its advent in 1990s. Recently, we procured da Vinci surgical system in our institution; and here, we present our initial experience of robot-assisted surgeries at our hospital. We also discuss the stepwise approach for successful implementation of the robotic surgical programme at our institute. Moreover, the importance of efficient use of this advanced but expensive technology has been highlighted. Materials and Methods: Retrospective analysis of the medical record of all the paediatric patients between the age ranges of 1–18 years who had undergone robotic-assisted laparoscopic surgery during April 2019–April 2019 was done. Medical record was reviewed for descriptive data, clinical presentation, investigations, operative details and follow-up. Statistical data were also obtained from medical superintendent office. Results: During April 2018–April 2019, total of 111 cases were operated across six specialities. Approximately 73% of cases (81/111) belonged to adult urology and gynaecology speciality. Less than 5% (5/111) of patients were in paediatric age group. The department of paediatric surgery performed one pyeloplasty, 3 ureteric reimplantation and 1 bladder diverticulum excision with robot assistance. The operative duration of the cases was comparable to the standard laparoscopic techniques. All patients are asymptomatic on follow-up visits. Conclusion: The robotic surgery is feasible in paediatric population and has favourable post-operative outcomes. Detailed planning and stepwise approach is key to the establishment of new robotic surgery programme in any institute.
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Affiliation(s)
- Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manish Pathak
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ayushi Vig
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Richards HW, Kulaylat AN, Cooper JN, McLeod DJ, Diefenbach KA, Michalsky MP. Trends in robotic surgery utilization across tertiary children’s hospitals in the United States. Surg Endosc 2020; 35:6066-6072. [DOI: 10.1007/s00464-020-08098-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
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9
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Boia ES, David VL. The Financial Burden of Setting up a Pediatric Robotic Surgery Program. ACTA ACUST UNITED AC 2019; 55:medicina55110739. [PMID: 31739631 PMCID: PMC6915423 DOI: 10.3390/medicina55110739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Robotic surgery is currently at the forefront of both adult and pediatric treatment. The main limit in the wide adoption of this technology is the high cost of purchasing and running the robotic system. This report will focus on the costs assessment of running a robotic program in a pediatric surgery center in Romania. Materials and Methods: In 12 months we performed 40 robot-assisted procedures in children. We recorded and analyzed data regarding their age, gender, pathological condition and comorbidities, surgical procedure, time of surgery, complications, hospital stay and related costs, medication, robotic instruments and consumables, additional cost, and income per case received from the National Insurance Company (NIC). Results: Mean cost per case was €3260.63 (€1880.07 to €9851.78) and was influenced by type of the procedure, intraoperative incidents, postoperative complication, and non-scheduled reinterventions (p < 0.05). The direct costs for operating the surgical robot were relatively constant, regardless of the surgical procedure (mean €1579.81). The reimbursement from the NIC ranged from 5% to 56% (mean 16.9%) of the total cost per case. Conclusion: In Romania, a pediatric surgery robotic program is not cost-efficient and cannot operate relying solely onto the health insurance system.
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10
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Molinaro F, Angotti R, Bindi E, Pellegrino C, Fusi G, Luzzi L, Tosi N, Messina M, Mattioli G. Low Weight Child: Can It Be Considered a Limit of Robotic Surgery? Experience of Two Centers. J Laparoendosc Adv Surg Tech A 2019; 29:698-702. [PMID: 30973303 DOI: 10.1089/lap.2017.0681] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: Robotic surgery should be considered a technical opportunity for many procedures in pediatric age. The purpose of this study is to verify the correlation between robotic procedures and low weight. Materials and Methods: It is a retrospective study (2013-2017). We included all patients who underwent robotic assisted surgery for major procedures in two Italian centers for pediatric surgery. All patients were divided into two groups (group A ≤15 kg and group B > 15 kg). Parameters considered were as follows: time to console, average time procedures, time of hospitalization, and minor/major complications. Statistical test used was Wilcoxon-Mann-Whitney test. Results: We enrolled 83 patients. Group A: 28 patients, medium weight 11.2 kg (range: 7-15 kg). Group B: 55 patients, average weight 40.8 kg (range: 15.2-120 kg). In relation to the outcomes considered, we found statistical significance in relation to surgical time and time at the console. Conclusions: The retrospective analysis of our case found that body weight cannot be considered an absolute contraindication for the execution of surgical procedures in robotics. The improvement of instruments permits to perform complex surgical procedures in low-weight children without additional difficulties. However, it is important to point out that the youngest child of our case had a weight of 7 kg.
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Affiliation(s)
- Francesco Molinaro
- 1 Section of Pediatric Surgery, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Rossella Angotti
- 1 Section of Pediatric Surgery, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Edoardo Bindi
- 1 Section of Pediatric Surgery, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Chiara Pellegrino
- 1 Section of Pediatric Surgery, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giulia Fusi
- 1 Section of Pediatric Surgery, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Luzzi
- 2 Thoracic Surgery, Siena University Hospital, Siena, Italy
| | - Nicola Tosi
- 3 Department of Urology, University of Siena, Siena, Italy
| | - Mario Messina
- 1 Section of Pediatric Surgery, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Girolamo Mattioli
- 4 Paediatric Surgery Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
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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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Steyaert H, Van Der Veken E, Joyeux L. Implementation of Robotic Surgery in a Pediatric Hospital: Lessons Learned. J Laparoendosc Adv Surg Tech A 2018; 29:136-140. [PMID: 30222503 DOI: 10.1089/lap.2018.0426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Since the late 1980s, minimally invasive surgery (MIS) has been one of the fastest growing approaches for surgical procedures. However, its development has reached a plateau. One of the reasons is the difficulty to operate on more complex cases, such as neonatal procedures. Some experts report outstanding outcomes for complex operations, but not all surgeons may be able to achieve the same results. Is robotic surgery (RS) a solution? METHODS To answer this question, we reviewed the current indications of RS for the pediatric population and the steps needed to incorporate the robotic surgical system in a children's hospital. We reported our experience and presented our first results and the encountered problems. RESULTS After a year and a half of experience with RS, several lessons were learned: (1) the current robotic surgical system cannot yet be considered a replacement to conventional MIS, (2) docking is less time consuming than expected, (3) postoperative pain is significantly decreased, (4) the absence of haptic feedback is still a matter of concern, and (5) costs can be afforded by sharing the RS with adult surgeons. CONCLUSIONS Based on our experience, the advantages seem to outweigh the drawbacks as it encourages team building and increases overall comfort for the surgeon. However, the current literature fails to prove that RS gives better results for pediatric patients. New advances in technology will probably help to overcome the encountered difficulties and the high costs.
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Affiliation(s)
- Henri Steyaert
- Department of Pediatric Surgery, Queen Fabiola Children's Hospital (HUDERF) , Universite Libre de Bruxelles (ULB), Brussels, Belgium
| | - Erwin Van Der Veken
- Department of Pediatric Surgery, Queen Fabiola Children's Hospital (HUDERF) , Universite Libre de Bruxelles (ULB), Brussels, Belgium
| | - Luc Joyeux
- Department of Pediatric Surgery, Queen Fabiola Children's Hospital (HUDERF) , Universite Libre de Bruxelles (ULB), Brussels, Belgium
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Abstract
BACKGROUND The rising prevalence of childhood obesity and concomitant increase in comorbid disease pose significant challenges for the health care system. While mounting evidence demonstrates the safety and efficacy of bariatric surgery for severely obese adolescents, the potential role of robotic technology has not been well defined. OBJECTIVE The aim of this study was to establish the safety and efficacy of robotic-assisted laparoscopic sleeve gastrectomy (RSG) in treating severe adolescent obesity. In addition, 30-day outcomes and hospital charges were compared to subjects undergoing RSG versus laparoscopic sleeve gastrectomy (LSG). METHODS A retrospective analysis of 28 subjects (14 LSG vs. 14 RSG) at a single institution was conducted. Data collection included demographics, body mass index, comorbidities, hospital length of stay (LOS), operative time, 30-day outcomes, and hospital charges. Analysis was performed using chi-square, Fisher's exact, and nonparametric Wilcoxon rank sum tests. RESULTS There were no differences in subject demographics or comorbidities. While median operative time was longer for RSG vs. LSG (132 vs. 100 min, p = 0.0002), the median LOS for RSG compared to LSG was shorter (69.6 vs. 75.9 h, p = 0.0094). In addition, RSG-related hospital charges were higher ($56,646 vs. $49,498, p = 0.0366). No significant differences in post-operative outcomes or complications were observed. CONCLUSIONS RSG is equally safe and efficacious when compared to LSG among adolescents. Similar to studies in adults, LOS is shortened while hospital charges are higher. Larger prospective studies are needed to gain insight regarding cost benefit ratios.
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Ballouhey Q, Clermidi P, Cros J, Grosos C, Rosa-Arsène C, Bahans C, Caire F, Longis B, Compagnon R, Fourcade L. Comparison of 8 and 5 mm robotic instruments in small cavities. Surg Endosc 2017; 32:1027-1034. [DOI: 10.1007/s00464-017-5781-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/28/2017] [Indexed: 12/11/2022]
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Díaz CE, Fernández R, Armada M, García F. A research review on clinical needs, technical requirements, and normativity in the design of surgical robots. Int J Med Robot 2017; 13. [PMID: 28105687 DOI: 10.1002/rcs.1801] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/04/2016] [Accepted: 11/21/2016] [Indexed: 12/14/2022]
Abstract
Nowadays robots play an important role in society, mainly due to the significant benefits they provide when utilized for assisting human beings in the execution of dangerous or repetitive tasks. Medicine is one of the fields in which robots are gaining greater use and development, especially those employed in minimally invasive surgery (MIS). However, due to the particular conditions of the human body where robots have to act, the design of these systems is complex, not only from a technical point of view, but also because the clinical needs and the normativity aspects are important considerations that have to be taken into account in order to achieve better performances and more secure systems for patients and surgeons. Thus, this paper explores the clinical needs and the technical requirements that will trace the roadmap for the next scientific and technological advances in the field of robotic surgery, the metrics that should be defined for safe technology development and the standards that are being elaborated for boosting the industry and facilitating systems integration.
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Affiliation(s)
- Carlos Eduardo Díaz
- Universidad Tecnológica del Valle de Toluca, Carretera del Departamento del D. F., Lerma, México
| | - Roemi Fernández
- Centre for Automation and Robotics CAR (CSIC-UPM), Madrid, Spain
| | - Manuel Armada
- Centre for Automation and Robotics CAR (CSIC-UPM), Madrid, Spain
| | - Felipe García
- Universidad Tecnológica del Valle de Toluca, Carretera del Departamento del D. F., Lerma, México
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Garbin N, Slawinski PR, Aiello G, Karraz C, Valdastri P. Laparoscopic Camera Based on an Orthogonal Magnet Arrangement. IEEE Robot Autom Lett 2016. [DOI: 10.1109/lra.2016.2528303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Zhang T, Wang X, Zhao L, Liu F, Chen H, Deng X, Peng C, Shen B. Transperitoneal robotic resection of benign primary retroperitoneal tumors: can it be widely used? Int J Med Robot 2015. [PMID: 26202698 DOI: 10.1002/rcs.1689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This article was aimed to show the safety, flexibility and other advantages of transperitoneal robot-assisted resection of benign primary retroperitoneal tumors. METHODS Ten patients underwent robotic surgeries, and 31 underwent laparotomy surgeries from 2012 to 2014. The perioperative data, including tumor size, operation time, and other parameters were analyzed. RESULTS The tumor sizes of the two groups were not different (robotic group vs laparotomy group: 5.47 vs 5.32 cm, respectively; P = 0.777). The differences in the blood loss (robotic group vs laparotomy group: 80.00 vs. 146.08 mL, respectively; P = 0.021), time of oral intake (robotic group vs laparotomy group: 2.12 vs. 3.42 d, respectively; P = 0.045) and post-operation hospital stay (robotic group vs laparotomy group: 5.40 vs. 8.77 d, respectively; P = 0.004) were statistically significant and lower in the robotic group. CONCLUSION Robot-assisted resection of benign retroperitoneal tumors is flexible and safe and provides better protection when complex lesions are removed. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tian Zhang
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xinjing Wang
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Liangchao Zhao
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Fei Liu
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Hao Chen
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaxing Deng
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Chenghong Peng
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Baiyong Shen
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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