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Appelbaum H. Perioperative and Operative Considerations for Minimally Invasive Surgery in Pediatric and Adolescent Gynecology. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00261-4. [PMID: 39098547 DOI: 10.1016/j.jpag.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/07/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
Minimally invasive surgery (MIS) techniques, including vaginoscopy, laparoscopy and robotic-assisted surgery (RAS), have revolutionized the field of gynecology, offering numerous benefits such as reduced postoperative pain, shorter hospital stays, and faster recovery. While these techniques are widely employed in adult gynecologic surgery, their application in pediatric and adolescent patients requires careful consideration due to anatomical differences, patient size, and specific surgical requirements in children. Various aspects of MIS in pediatric and adolescent gynecology, including patient positioning, laparoscopic and robotic instrument choices, trocar placement, surgical techniques, and perioperative pediatric adaptations to MIS are discussed. The findings highlight the unique challenges and opportunities in performing MIS for pediatric and adolescent patients undergoing gyn surgery, emphasizing the need for specialized training and multidisciplinary collaboration.
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Affiliation(s)
- Heather Appelbaum
- Associate Professor, Obstetrics and Gynecology, Hackensack School of Medicine, Chief, Division of Pediatric and Adolescent Gynecology; K. Hovnanian Children's Hospital at Jersey Shore University Medical Center
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Killaars REM, Visschers RGJ, Dirix M, Theeuws OPF, Eurlings R, Dinjens DJH, Cakir H, van Gemert WG. Robotic-Assisted Surgery in Children Using the Senhance ® Surgical System: An Observational Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:935. [PMID: 39201870 PMCID: PMC11352959 DOI: 10.3390/children11080935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND Robotic-assisted surgery (RAS) holds many theoretical advantages, especially in pediatric surgical procedures. However, most robotic systems are dedicated to adult surgery and are less suitable for smaller children. The Senhance® Surgical System (SSS®), providing 3 mm and 5 mm instruments, focuses on making RAS technically feasible for smaller children. This prospective observational study aims to assess whether RAS in pediatric patients using the SSS® is safe and feasible. METHODS AND RESULTS A total of 42 children (aged 0-17 years, weight ≥ 10 kg) underwent a RAS procedure on the abdominal area using the SSS® between 2020 and 2023. The study group consisted of 20 male and 22 female individuals. The mean age was 10.7 years (range 0.8 to 17.8 years), with a mean body weight of 40.7 kg (range 10.1 to 117.3 kg). The 3-mm-sized instruments of the SSS® were used in 12 of the 42 children who underwent RAS. The RAS procedures were successfully completed in 90% of cases. The conversion rate to conventional laparoscopy was low (10%), and there were no conversions to open surgery. One of the 42 cases (2%) experienced intraoperative complications, whereas six children (14%) suffered from a postoperative complication. Overall, 86% of the patients had an uncomplicated postoperative course. CONCLUSIONS The results of the current observational study demonstrate the safety and feasibility of utilizing the SSS® for abdominal pediatric RAS procedures. The study provides new fundamental information supporting the implementation of the SSS® in clinical practice in pediatric surgery.
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Affiliation(s)
- Rianne E. M. Killaars
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism NUTRIM, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Ruben G. J. Visschers
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Marc Dirix
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Olivier P. F. Theeuws
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Roxanne Eurlings
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism NUTRIM, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Dianne J. H. Dinjens
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Hamit Cakir
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Wim G. van Gemert
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism NUTRIM, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
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Jeong YC, Kang A, Ko DY, Youn JK, Kim HY. Robotic surgeries in pediatric patients: an early experience in a single center. Ann Surg Treat Res 2024; 106:322-329. [PMID: 38868582 PMCID: PMC11164661 DOI: 10.4174/astr.2024.106.6.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/22/2024] [Accepted: 03/06/2024] [Indexed: 06/14/2024] Open
Abstract
Purpose Robotic surgery (RS) has the advantages of 3-dimensional view, optical magnification, motional scaling, and improved ergonomics and degree of freedom. Although RS has widely been performed on pediatric patients lately, there are still numerous restrictions and ambiguous indications. The purpose of this study was to report our early experience with RS on pediatric patients at a single center. Methods Electronic medical records of patients who underwent RS with the da Vinci Xi surgical platform (Intuitive Surgical, Inc.) in Seoul National University Children Hospital from November 2019 to August 2021 were reviewed retrospectively. The median follow-up was 21.0 months (range, 12.3-31.8 months). An online survey was conducted to investigate satisfaction with robotic surgical scars. Results Fifty-four patients underwent robotic surgeries (median age at operation, 11.1 years [range, 0.1-17.8 years]). In our hospital, patients had 20 different kinds of robotic surgeries, including choledochal cyst excision with hepaticojejunostomy, ovarian mass excision, and others. Median operation time and console time were 157.5 minutes (range, 45-505 minutes) and 40 minutes (range, 11-360 minutes), respectively. All cases were done without conversion into open or laparoscopic methods. Postoperative complications were found in 5 patients. According to an online survey, over half of patients (60.9%) answered that they felt satisfied with scars. Conclusion Our early experience demonstrated the safety and feasibility of RS in children with a range of diagnoses and complicated procedures. With more experience, RS could be an alternative to traditional open or laparoscopic operations in pediatric patients. Further studies are needed to clarify indications of pediatric RS.
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Affiliation(s)
- Ye-Chan Jeong
- Division of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ayoung Kang
- Division of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea
| | - Da-Young Ko
- Division of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea
| | - Joong-Kee Youn
- Division of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Young Kim
- Division of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Gao Y, Han X, Tan Z. Evaluation of robot-assisted laparoscopic versus conventional laparoscopic hiatal hernia repair in children. J Robot Surg 2024; 18:32. [PMID: 38231355 DOI: 10.1007/s11701-023-01805-6] [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: 07/23/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024]
Abstract
Laparoscopic approach is the gold standard for repairing hiatal hernia (HH). Robotic technology is now widely accepted, but it is rarely used in children with HH. Our aim was to evaluate the clinical effect of robot-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS) in the treatment of HH in children. A retrospective study was carried out in patients undergoing elective robot-assisted laparoscopic or conventional laparoscopic HH repair at a tertiary academic hospital from January 2020 to December 2022, and patients who met the inclusion criteria were included in this study. We compared the characteristics and clinical results of patients to understand the effects of the two surgical methods. Forty-six patients (CLS, group 1, n = 25; RALS, group 2, n = 21) met the inclusion criteria. All operations were performed by one experienced pediatric surgeon. In this study, no significant differences were found in terms of gender, age, weight, size of HH, total operation times, the effective operation time (excluding setup time) and complications between group 1 and group 2. (P = 0.979, P = 0.438, P = 0.265, P = 0.800, P = 0.122, P = 0.427 and P = 0.478, respectively). However, the intraoperative bleeding, the intensive care unit (ICU) admission, postoperative hospital length of stay (LOS) and postoperative fasting time were significantly less for RALS (P = 0.016, P = 0.040, P = 0.035 and P = 0.025, respectively). Meanwhile, the overall charges were significantly higher in group 2 (P < 0.01). Despite higher charges for robotic-assisted HH repair, it is a safe and reliable alternative to CLS and was associated with better outcomes in children.
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Affiliation(s)
- Yue Gao
- Department of Paediatric Thoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, Zhejiang, China
| | - Xu Han
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Zheng Tan
- Department of Paediatric Thoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, Zhejiang, China.
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