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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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Jacobson JC, Scrushy MG, Gillory LA, Pandya SR. Utilization of robotics in pediatric surgical oncology. Semin Pediatr Surg 2023; 32:151263. [PMID: 36753917 DOI: 10.1016/j.sempedsurg.2023.151263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Despite increasing implementation of robotic surgery and minimally invasive techniques within adult surgical oncology and pediatric general surgery, the utilization of robotic-assisted resections for pediatric tumors has been met with controversy. The robotic platform affords numerous advantages over conventional surgical techniques. However, limited data and guidelines regarding patient selection, indications for the robotic approach, and long-term oncologic outcomes have delayed the widespread adoption of robotic-assisted resection of pediatric tumors. This paper reviews the benefits, limitations, and existing guidelines and data regarding the utilization of robotics in pediatric surgical oncology.
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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
| | - Marinda G Scrushy
- 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
| | - Lauren A Gillory
- 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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Angotti R, Raffaele A, Molinaro F, Riccipetitoni G, Chiesa PL, Lisi G, Mattioli G, Alberti D, Boroni G, Mariscoli F, Martino A, Pelizzo G, Maffi M, Messina M, Lima M. Rise of pediatric robotic surgery in Italy: a multicenter observational retrospective study. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-021-00144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The minimally invasive surgery (MIS) in term of robot-assisted surgery changed in a dramatic way the surgical approach either in adults or children. For many specialties (urology, gynecology, general surgery) robotic surgery rapidly became the gold standard for some procedures, while the experience in pediatric population is not wide for some reasons. The aim of this study is to retrospective analyze trends of application of robotic surgery in pediatric patients across the country, focusing on indications, limitations, development, and training acquired by national experience and in comparison to the literature.
Methods
We made a retrospective multicenter study on behalf of Italian Society of Pediatric Surgery. We performed a census among all pediatric surgery units in the country to enroll those performing robotic surgery on children between 2013 and 2019.
Results
We enrolled 7 pediatric surgery referral Centers (Ancona, Bologna, Brescia, Genova, Pavia, Pescara, Siena). A total of 303 patients were included in the study, 164 males (54%) and 139 females (46%). The most commonly performed interventions for each anatomic area were respectively atypical pulmonary resection (38%), pyeloplasty (49%), and fundoplication (30%).
Conclusions
Since its first application in Italy, about 10 years ago, several considerations were made about application and feasibility of robotics in children.
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Al Quran T, Rousan L, Aljaafreh A, Bataineh Z. Laparoscopic management of Rhabdomyosarcoma of common Bile duct, Case report. Ann Med Surg (Lond) 2020; 59:118-121. [PMID: 33005400 PMCID: PMC7519210 DOI: 10.1016/j.amsu.2020.09.023] [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: 08/06/2020] [Revised: 09/06/2020] [Accepted: 09/06/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Embryonal Rhabdomyosarcoma (ERMS) is a malignant soft tissue musculoskeletal tumor which constitutes about 0.06% of all malignancies affecting children. Biliary tract ERMS is still rare, though it is considered the most common cause of malignant obstructive jaundice in children. CASE PRESENTATION A report of a 2-year-old boy, who was presented with recurrent episodes of scleral icterus of three months duration, is added to the related literature. His labs went with obstructive jaundice and the radiological investigations were consistent with a diagnosis of choledochal cyst. The found mass was suspected to be an ERMS of common bile duct and turned out to be so by the histopathology. He was managed totally by laparoscope, both excision and hepaticojejunostomy reconstruction, which is an extremely uncommon entity. CONCLUSION Common Bile Duct Rhabdomyosarcoma is rare and diagnosis at this anatomical site is difficult. Our case highlights the feasibility of laparoscopic resection and hepaticojejunostomy reconstruction with very good results at 16-month follow up and parents' gratitude as well.
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Affiliation(s)
- T.M. Al Quran
- Department of Public Health/Community Medicine and Family Medicine, Jordan
| | - L.A. Rousan
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Jordan
| | - A.M. Aljaafreh
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Jordan
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Soares KC, Goldstein SD, Ghaseb MA, Kamel I, Hackam DJ, Pawlik TM. Pediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int 2017; 33:637-650. [PMID: 28364277 DOI: 10.1007/s00383-017-4083-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 02/07/2023]
Abstract
Choledochal cysts are rare congenital disorders first described by Vater and Ezler in 1723. Their exact etiology remains incompletely understood; however, an anomalous pancreaticobiliary union (APBDU) and subsequent reflux of biliary contents into the biliary tree are thought to play a role. Accordingly, APBDU-associated choledochal cyst patients are significantly more likely to have evidence of hepatitis, cholangitis or pancreatitis and pathologically confirmed inflammation. In 1977, Todani and colleagues modified the original Alonso-Lej classification to include five types of CC. Type I and IV are the most common and most likely to be associated with malignancy. The majority of choledochal cysts are diagnosed in childhood. Clinical presentation varies and most often consists of nonspecific abdominal pain. Diagnosis is typically accomplished using multimodality imaging techniques including computed tomography, magnetic resonance imaging, ultrasound and MRCP. The use of diagnostic PTC and ERCP in CC has been largely replaced by MRCP. Appropriate management consists of prompt, complete cyst excision followed by restoration of biliary enteric continuity when necessary. Minimally invasive CC resection in the pediatric population has demonstrated acceptable outcomes. Prognosis is generally excellent; however, malignancy risk remains higher than the general population even after complete surgical excision.
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Affiliation(s)
- Kevin C Soares
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Blalock 688, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Seth D Goldstein
- Division of General Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounes A Ghaseb
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab Kamel
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David J Hackam
- Division of General Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Department of Surgery, Wexner Medical Center, Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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