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Scrushy MG, Jacobson JC, Pandya SR, Gillory LA. Robotic repair of pediatric hernias: Current techniques and practices. Semin Pediatr Surg 2023; 32:151261. [PMID: 36736163 DOI: 10.1016/j.sempedsurg.2023.151261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The use of minimally invasive surgical techniques has gained popularity in pediatric surgery due to decreased length of stay, improved post-operative pain and smaller incisions. Laparoscopic assisted robotic surgical procedures are becoming more common in adults as they carry all of the benefits of traditional MIS but also allow for improved dexterity, visualization and surgeon ergonomics. In adults, hernia repairs are one of the most commonly performed robotic cases but adaption to pediatric repairs has been slower. Case reports and small case series have described a number of various types of pediatric hernia repairs including congenital diaphragmatic hernias, paraesophageal hernias and inguinal hernias. These cases have demonstrated that robotic repair of pediatric hernias is safe and feasible with minimal documented post-operative complications or recurrence. Future directions should focus on larger patient volume in order to assess outcomes between traditional laparoscopic and robotic approaches.
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Affiliation(s)
- Marinda G Scrushy
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA
| | - Jillian C Jacobson
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA
| | - Samir R Pandya
- Division of Pediatric Surgery, Children's Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX, 75235 USA; Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA
| | - Lauren A Gillory
- Division of Pediatric Surgery, Children's Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX, 75235 USA; Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA.
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Shu B, Feng X, Martynov I, Lacher M, Mayer S. Pediatric Minimally Invasive Surgery-A Bibliometric Study on 30 Years of Research Activity. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081264. [PMID: 36010154 PMCID: PMC9406539 DOI: 10.3390/children9081264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022]
Abstract
Background: Pediatric minimally invasive surgery (MIS) is a standard technique worldwide. We aimed to analyze the research activity in this field. Methods: Articles on pediatric MIS (1991−2020) were analyzed from the Web of Science™ for the total number of publications, citations, journals, and impact factors (IF). Of these, the 50 most cited publications were evaluated in detail and classified according to the level of evidence (i.e., study design) and topic (i.e., surgical procedure). Results: In total, 4464 publications and 53,111 citations from 684 journals on pediatric MIS were identified. The 50 most cited papers were published from 32 institutions in the USA/Canada (n = 28), Europe (n = 19), and Asia (n = 3) in 12 journals. Four authors (USA/Europe) contributed to 26% of the 50 most cited papers as first/senior author. Hot topics were laparoscopic pyeloplasty (n = 9), inguinal hernia repair (n = 7), appendectomy, and pyloromyotomy (n = 4 each). The majority of publications were retrospective studies (n = 33) and case reports (n = 6) (IF 5.2 ± 3.2; impact index 16.5 ± 6.4; citations 125 ± 39.4). They were cited as often as articles with high evidence levels (meta-analyses, n = 2; randomized controlled trials, n = 7; prospective studies, n = 2) (IF 12.9 ± 22.5; impact index 14.0 ± 6.5; citations 125 ± 34.7; p > 0.05). Conclusions: Publications on laparoscopic pyeloplasty, inguinal hernia repair, appendectomy, and pyloromyotomy are cited most often in pediatric MIS. However, the relevant number of studies with strong evidence for the advantages of MIS in pediatric surgery is missing.
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Bindi E, Todesco C, Nino F, Torino G, Gentilucci G, Cobellis G. Robotic Surgery: Is There a Possibility of Increasing Its Application in Pediatric Settings? A Single-Center Experience. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1021. [PMID: 35884005 PMCID: PMC9325175 DOI: 10.3390/children9071021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
Introduction: Robotic surgery has shown explicit benefits and advantages in adults, but it is not yet strongly established in the pediatric population, even though its popularity is increasing, especially in the urologic field. Materials and methods: In this article we present our experience with the Da Vinci System (SI first and XI nowadays) at our pediatric institution in order to analyze our progress over the years. We considered all patients from the start of the robotic surgery program in 2016 until the end of 2021, dividing them into general abdominal surgery and genitourinary surgery. Analyzed data were the patient's demographic, details of surgery, and intra and post-operative complications. Results: The total number of patients (pts) included in this study was 76, of whom 40 (52%) were male and 36 (48%) were female. The mean age at surgery was 90.9 months (range 10-207 months), and the mean weight at surgery was 29.3 kg (range 9.5-68 kg). There were 18 general abdominal robotic surgeries and 58 genitourinary robotic surgeries performed. The most performed surgeries in these two categories were fundoplication for gastro-oesophageal reflux disease (11%) and Anderson-Hynes pyeloureteroplasty. The mean operative time was 224.2 min (range 72-530 min): the mean times in the two groups (general abdominal surgery and genitourinary surgery) were 165 min (range 84-204 min) and 194 min (range 95-360 min), respectively. A total of four (5%) minor complications were reported. The total conversions were two (2.6%) and the mortality rate was 0%. Conclusions: Pediatric robotic surgery is a field of considerable interest and it is rapidly expanding. In our experience, it is evident how the learning curve has increased gradually, but steadily, allowing us to advance from standardized surgery, such as fundoplication and pieloplasty, towards a more technically complex one, achieving the same good results. We believe that robotic surgery is very respectful of tissues and feasible, especially for reconstructive surgery. For these reasons, it could become of common use also in the pediatric population, overcoming impediments such as excessive cost and the lack of pediatric instruments, in order to be able to treat children with a progressively lower age and weight.
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Affiliation(s)
- Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children’s Hospital, 60123 Ancona, Italy; (C.T.); (F.N.); (G.T.); (G.G.); (G.C.)
| | - Camilla Todesco
- Pediatric Surgery Unit, Salesi Children’s Hospital, 60123 Ancona, Italy; (C.T.); (F.N.); (G.T.); (G.G.); (G.C.)
| | - Fabiano Nino
- Pediatric Surgery Unit, Salesi Children’s Hospital, 60123 Ancona, Italy; (C.T.); (F.N.); (G.T.); (G.G.); (G.C.)
| | - Giovanni Torino
- Pediatric Surgery Unit, Salesi Children’s Hospital, 60123 Ancona, Italy; (C.T.); (F.N.); (G.T.); (G.G.); (G.C.)
| | - Gianluca Gentilucci
- Pediatric Surgery Unit, Salesi Children’s Hospital, 60123 Ancona, Italy; (C.T.); (F.N.); (G.T.); (G.G.); (G.C.)
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children’s Hospital, 60123 Ancona, Italy; (C.T.); (F.N.); (G.T.); (G.G.); (G.C.)
- Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Università Politecnica of Marche, 60020 Ancona, Italy
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Li W, Lin M, Hu H, Sun Q, Su C, Wang C, Li Y, Li Y, Chen J, Luo Y. Surgical Management of Hirschsprung's Disease: A Comparative Study Between Conventional Laparoscopic Surgery, Transumbilical Single-Site Laparoscopic Surgery, and Robotic Surgery. Front Surg 2022; 9:924850. [PMID: 35860198 PMCID: PMC9289258 DOI: 10.3389/fsurg.2022.924850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHirschsprung's disease (HD) is a commonly digestive malformation in children that usually requires surgery. This study aims to evaluate the short-term efficacy of conventional laparoscopic surgery (CLS), transumbilical single-hole laparoscopic surgery (TU-LESS), and robotic surgery (RS) in the treatment of Hirschsprung's disease.Methods90 patients with Hirschsprung's disease undergone laparoscopic surgery at our center between 2015 and 2019, divided into three groups (group CLS, TU-LESS and RS), were retrospectively analysed.ResultsCLS and TU-LESS group showed no significant difference in operation duration (P > 0.05) but shorter operation duration than the RS group (P < 0.05). RS group had highest overall SCAR scores, while TU-LESS group had the lowest one (P < 0.05). Other parameters such as operative blood loss, hospital stays, recovery time of digestive function, postoperative complications had no significant difference among the three groups (P > 0.05).ConclusionThe three surgical methods for HD revealed similar efficacy, where TU-LESS and CLS spent less time than RS; TU-LESS led to the most aesthetic effect, followed by CLS and RS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yige Luo
- Correspondence: Yige Luo Jiabo Chen
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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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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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Xie XX, Wang N, Wang ZH, Zhu YY, Wang JR, Wang XQ. Robotic-assisted resection of ovarian tumors in children: A case report and review of literature. World J Clin Cases 2019; 7:2542-2548. [PMID: 31559290 PMCID: PMC6745331 DOI: 10.12998/wjcc.v7.i17.2542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ovarian tumors are common gynecological diseases in children, and the most commonly seen ovarian tumors are germ cell tumors. Robotic surgery is the new access for children ovarian tumors. CASE SUMMARY From June to October 2017, 4 children with ovarian tumors were admitted and treated in the Department of Pediatric Surgery of People's Liberation Army General Hospital. The mean age, height, and weight of these patients were 7.5 (1-13) years old, 123.75 (71-164) cm, and 36.8 (8.5-69.5) kg, respectively. Robotic-assisted resection of ovarian tumors was performed for all 4 patients. The 3-port approach was used for robotic manipulation. The surgical procedures were as follows. After creation of the pneumoperitoneum, the robotic scope was placed to explore and find the left ovarian tumor. The trocars for robotic arms 1 and 2 were placed at the sites to the lower right and left of the port of the scope. The tumor capsule in the fallopian tube was incised, and the tumor was completely stripped by an electric hook along the junction of the tumor and the capsule. The resected tumor was completely removed using an endobag. The average docking time of the robotic system was 18.5 min, the average operative time was 120 min, and the average blood loss was 20 mL. No drainage tube was placed except in one patient with a mucinous tumor of the ovary. No fever, pelvic fluid, or intestinal obstruction was reported after surgery. No antibiotics were used during the perioperative period, and the average length of hospital stay after surgery was 3 d. CONCLUSION Robotic-assisted resection of ovarian tumors is a simple, safe, and effective surgical procedure for selected patients.
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Affiliation(s)
- Xiao-Xiao Xie
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, China
| | - Ning Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| | - Zi-Hao Wang
- The Fourth Military Medical University, Xi’an 710032, Shanxi Province, China
| | - Yue-Yue Zhu
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Jing-Ru Wang
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Xian-Qiang Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
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9
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Anesthesia experience of pediatric robotic surgery in a University Hospital. J Robot Surg 2018; 13:141-146. [DOI: 10.1007/s11701-018-0834-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/03/2018] [Indexed: 12/16/2022]
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11
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Current perspectives in robotic assisted pediatric surgery. APOLLO MEDICINE 2014. [DOI: 10.1016/j.apme.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cundy TP, Harling L, Marcus HJ, Athanasiou T, Darzi AW. Meta analysis of robot-assisted versus conventional laparoscopic fundoplication in children. J Pediatr Surg 2014; 49:646-52. [PMID: 24726129 DOI: 10.1016/j.jpedsurg.2013.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/30/2013] [Accepted: 12/06/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Minimally invasive fundoplication may be performed using either a robot-assisted (RF) or conventional laparoscopic (LF) technique. Evidence comparing RF and LF in children remains unclear. This study aims to elucidate the comparative safety and efficacy of RF versus LF by systematic review and meta-analysis. METHODS Comparative studies investigating RF versus LF in children were identified from multiple electronic literature databases. Meta-analysis was performed using random effects modeling. Safety parameters investigated were post-operative morbidity and intra-operative conversions. Efficacy outcomes of interest were operative success, re-operation, post-operative complications, length of hospital stay (LOS), total operating time (OT), analgesia requirement, and cost. RESULTS Six observational studies met inclusion criteria, reporting outcomes of 297 children. No randomized controlled trials were identified. Pooled analysis determined no statistically significant differences between RF and LF for conversions, OT, LOS, and post-operative complications. There was no standardized follow up beyond the early post-operative period to enable data synthesis for remaining outcomes of interest. Limited evidence indicates higher costs with RF. CONCLUSIONS Safety and short-term efficacy seem comparable between RF and LF in children. There is insufficient evidence to assess comparative effectiveness for many important procedure specific outcome measures. Higher quality and longer follow-up studies are required.
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Affiliation(s)
- Thomas P Cundy
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College, London, UK; Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK.
| | - Leanne Harling
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - Hani J Marcus
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College, London, UK; Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
| | - Ara W Darzi
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College, London, UK; Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK
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Chaussy Y, Becmeur F, Lardy H, Aubert D. Robot-Assisted Surgery: Current Status Evaluation in Abdominal and Urological Pediatric Surgery. J Laparoendosc Adv Surg Tech A 2013; 23:530-8. [DOI: 10.1089/lap.2012.0192] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Yann Chaussy
- Department of Pediatric Surgery, Hospital Saint-Jacques, Centre Hospitalier Regional Universitaire de Besançon, Besançon, France
| | - François Becmeur
- Department of Pediatric Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Clocheville Hospital, Centre Hospitalier Regional Universitaire de Tours, Tours, France
| | - Didier Aubert
- Department of Pediatric Surgery, Hospital Saint-Jacques, Centre Hospitalier Regional Universitaire de Besançon, Besançon, France
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The first decade of robotic surgery in children. J Pediatr Surg 2013; 48:858-65. [PMID: 23583146 DOI: 10.1016/j.jpedsurg.2013.01.031] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/03/2013] [Accepted: 01/20/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Robotic surgery offers technological solutions to current challenges of minimal access surgery, particularly for delicate and dexterous procedures within spatially constrained operative workspaces in children. The first robotic surgical procedure in a child was reported in April 2001. This review aims to examine the literature for global case volumes, trends, and quality of evidence for the first decade of robotic surgery in children. METHODS A systematic literature search was performed for all reported cases of robotic surgery in children during the period of April 2001 to March 2012. RESULTS Following identification of 220 relevant articles, 137 articles were included, reporting 2393 procedures in 1840 patients. The most prevalent gastrointestinal, genitourinary, and thoracic procedures were fundoplication, pyeloplasty, and lobectomy, respectively. There was a progressive trend of increasing number of publications and case volumes over time. The net overall reported conversion rate was 2.5%. The rate of reported robot malfunctions or failures was 0.5%. CONCLUSIONS Robotic surgery is an expanding and diffusing innovation in pediatric surgery. Future evolution and evaluation should occur simultaneously, such that wider clinical uptake may be led by higher quality and level of evidence literature.
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Krauss A, Neumuth T, Wachowiak R, Donaubauer B, Korb W, Burgert O, Muensterer OJ. Laparoscopic versus robot-assisted Nissen fundoplication in an infant pig model. Pediatr Surg Int 2012; 28:357-62. [PMID: 22200733 DOI: 10.1007/s00383-011-3045-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgical robots are designed to facilitate dissection and suturing, although objective data on their superiority are lacking. This study compares conventional laparoscopic Nissen fundoplication (CLNF) to robot-assisted Nissen fundoplication (RANF) using computer-based workflow analysis in an infant pig model. METHODS CLNF and RANF were performed in 12 pigs. Surgical workflow was segmented into phases. Time required to perform specific actions was compared by t test. The quality of knot-tying was evaluated by a skill scoring system. Cardia yield pressure (CYP) was determined to test the efficacy of the fundoplications, and the incidence of complications was compared. RESULTS There was no difference in average times to complete the various phases, despite faster robotic knot-tying (p = 0.001). Suturing quality was superior in CLNF (p = 0.02). CYP increased similarly in both groups. Workflow-interrupting hemorrhage and pneumothorax occurred more frequently during CLNF (p = 0.040 and 0.044, respectively), while more sutures broke during RANF (p = 0.001). CONCLUSION The robot provides no clear temporal advantage compared to conventional laparoscopy for fundoplication, although suturing was faster in RANF. Fewer complications were noted using the robot. RANF and CLNF were equally efficient anti-reflux procedures. For robotic surgery to manifest its full potential, more complex operations may have to be evaluated.
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Affiliation(s)
- Alexandra Krauss
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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Robotic gastric banding in children and adolescents: a comparative study. Surg Endosc 2011; 25:3647-51. [DOI: 10.1007/s00464-011-1772-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 05/05/2011] [Indexed: 12/15/2022]
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Abstract
BACKGROUND The purpose of this study was to assess the safety and feasibility of performing robot-assisted pediatric surgery using the da Vinci Surgical System in a variety of surgical procedures. METHODS A retrospective review of 144 robot-assisted pediatric surgical procedures performed in our institution between June 2004 and December 2007 was done. The procedures included the following: 39 fundoplications; 34 cholecystectomies; 25 gastric bandings; 13 splenectomies; 4 anorectal pull-through operations for imperforate anus; 4 nephrectomies; 4 appendectomies; 4 sympathectomies; 3 choledochal cyst excisions with hepaticojejunostomies; 3 inguinal hernia repairs; two each of the following: liver cyst excision, repair of congenital diaphragmatic hernia, Heller's myotomy, and ovarian cyst excision; and one each of the following: duodeno-duodenostomy, adrenalectomy, and hysterectomy. RESULTS A total of 134 procedures were successfully completed without conversion; 7 additional cases were converted to open surgery, and 3 were converted to laparoscopic surgery. There were no system failures (e.g., setup joint, arm, or camera malfunction; power error; monocular or binocular loss; metal fatigue or break of surgeon's console hand piece; software incompatibility). There was one esophageal perforation and two cases of transient dysphagia following Nissen fundoplication. The mean patient age was 8.9 years, and the mean patient weight was 57 kg. CONCLUSIONS Robot-assisted surgery appears to be safe and feasible for a number of pediatric surgical procedures. Further system improvement and randomized studies are required to evaluate the benefits, if any, and the long-term outcomes of robotic surgery.
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Robotic-assisted surgery in children: advantages and limitations. J Robot Surg 2010; 4:19-22. [DOI: 10.1007/s11701-010-0181-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 03/29/2009] [Indexed: 10/19/2022]
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Abstract
OBJECTIVES This article reviews the evidence regarding the feasibility, safety, benefits, limitations, and costs of robotically assisted surgery in children, evaluates how the technology compares with other pediatric surgical techniques, and provides insights about the near and more-distant future of the technology. METHODS The peer-reviewed medical pediatric literature was searched for studies that provided evidence of the feasibility and safety of robotic surgery in children and for studies that compared pediatric robotic surgery with conventional laparoscopic surgery or open surgery. RESULTS A total of 8 case series and 5 studies comparing robotic surgery with open or conventional laparoscopic surgery met the selection criteria for review. A few small studies that focused on rare complex surgical procedures also were reviewed. All studies were designed to evaluate the feasibility and safety of robotic surgery in children. None of the studies was randomized, and some studies had a retrospective design. These studies demonstrated that a number of routine, robotically assisted, laparoscopic and thoracic procedures were feasible and safe when performed by surgeons experienced in the technique, although robotic surgery did not provide superior outcomes, compared with traditional laparoscopic and open surgery. The advantages of the robotic system were best seen in complex procedures that involved areas that were difficult to access and in procedures in which dissection of delicate, anatomic structures was required. CONCLUSIONS Robotic surgery is feasible and safe for a number of pediatric surgical procedures, but evidence that it offers better clinical outcomes than conventional open or laparoscopic techniques is lacking.
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Affiliation(s)
- Goedele van Haasteren
- Hayes Inc, Independent Health Technology Assessment Company, Lansdale, Pennsylvania 19446, USA.
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20
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Müller-Stich BP, Reiter MA, Mehrabi A, Wente MN, Fischer L, Köninger J, Gutt CN. No relevant difference in quality of life and functional outcome at 12 months' follow-up-a randomised controlled trial comparing robot-assisted versus conventional laparoscopic Nissen fundoplication. Langenbecks Arch Surg 2009; 394:441-6. [PMID: 19165497 DOI: 10.1007/s00423-008-0446-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 11/28/2008] [Indexed: 02/01/2023]
Abstract
PURPOSE The present randomised pilot trial was designed to compare robot-assisted (RALF) and conventional laparoscopic fundoplication (CLF) focussing on post-operative quality of life (QOL) and functional outcome. Any long-lasting advantages for patients in this regard could be a justification for the use of RALF for the treatment of gastroesophageal reflux disease (GERD). METHODS Forty patients with GERD were randomised to either RALF or to CLF. During a follow-up period of 12 months, patients' QOL and functional outcome were investigated using disease-specific questionnaires. RESULTS There were no significant differences in the mean QOL (1.3 versus 1.1; P = 0.374) and functional outcome (1.27 versus 1.3; P = 0.913) between both groups. Minor side effects such as bloating and persistent diarrhoea were present in four patients of each group. CONCLUSION The present study did not show any benefit for RALF over CLF regarding QOL and functional outcome at 12 months' follow-up.
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Affiliation(s)
- B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Sinha CK, Haddad M. Robot-assisted surgery in children: current status. J Robot Surg 2008; 1:243-6. [PMID: 25484971 PMCID: PMC4247450 DOI: 10.1007/s11701-007-0054-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Accepted: 12/05/2007] [Indexed: 11/30/2022]
Abstract
The horizon of robotic paediatric surgery has grown in leaps and bounds with advances in technology. The aim of this study was to analyse the extent of robotic involvement in paediatric surgical practice. A systematic database search was performed. Data about children who had undergone robot-assisted procedures were reviewed retrospectively from all published reports up to October 2007. Success rates were defined in term of completion of the procedures, their complications, and the time taken. These results were further studied in comparison with the procedures performed by open and laparoscopic methods. A total of 31 studies were identified describing 566 patients. Of these, four studies were case control, comparing with either laparoscopic or open procedures, one study was a prospective trial, and the rest of the studies were either case reports or series. The most common robotic system used was the da Vinci (23 studies) followed by the Zeus (four studies). The mean age of the children was 8.3 years. The commonest operation was pyeloplasty (141 cases), followed by fundoplication (122 cases) and patent ductus arteriosus ligation (50 cases). The mean operation time for robot-assisted pyeloplasty was 221 min (open pyeloplasty 214 min). The mean operation times for fundoplication were robotic, 170 min, laparoscopic, 158 min, and open, 121 min. The mean operation times for patent ductus arteriosus ligation were 166 min (robotic) and 83 min (open). Overall conversion rate for all paediatric robotic procedures was 4.7% and complications ranged from 0 to 15%. For robotic fundoplications the conversion and complication rates were 0.8 and 3.3%, respectively. For robotic pyeloplasties the conversion and complication rates were 2.1 and 3.5%, respectively. Many other major operations were performed successfully. All studies recommended robotic procedure as safe and feasible. Currently, the most common robotic operations in practice are pyeloplasties and fundoplications. Most of the authors concluded that, despite taking more time, robotic surgery enables more refined hand–eye coordination, superior suturing skills, better dexterity, and precise dissection with minimal conversion and complication rates. The widespread acceptance of this technology largely depends on solving the issues: learning curve; suitable machine size for neonates and infants; ensuring efficacy and safety in all operations; and, most importantly, making this procedure cost effective, so as to cater for the needs of most, if not all, children.
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Affiliation(s)
- C K Sinha
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, London, SW10 9NH UK
| | - M Haddad
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, London, SW10 9NH UK
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Woo RK, Peterson DA, Le D, Gertner ME, Krummel T. Robot-Assisted Surgery: Technology and Current Clinical Status. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kenngott HG, Neuhaus J, Müller-Stich BP, Wolf I, Vetter M, Meinzer HP, Köninger J, Büchler MW, Gutt CN. Development of a navigation system for minimally invasive esophagectomy. Surg Endosc 2007; 22:1858-65. [PMID: 18157716 DOI: 10.1007/s00464-007-9723-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 10/25/2007] [Accepted: 11/14/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND A major challenge of minimally invasive esophagectomy is the uncertainty about the exact location of the tumor and associated lymph nodes. This study aimed to develop a navigation system for visualizing surgical instruments in relation to the tumor and anatomic structures in the chest. METHODS An immobilization device consisting of a vacuum mattress fixed to a stretcher was built to decrease patient movement and organ deformation. Computer tomography (CT) markers were embedded in the stretcher at a defined distance to a detachable plate with optical markers on the side of the stretcher. A second plate of optical markers was fixed to the operating instrument. These two optical marker plates were tracked with an optical tracking system. Their positions were then registered in a preoperative CT data set using the authors' navigation software. This allowed a real-time visualization of the instrument and target structures. To assess the accuracy of the system, the authors designed a phantom consisting of a box containing small spheres in a specific three-dimensional layout. The positions of the spheres were first measured with the navigation system and then compared with the known real positions to determine the accuracy of the system. RESULTS In the accuracy assessment, the navigation system showed a precision of 0.95 +/- 0.78 mm. In a test data set, the instrument could be successfully navigated to the tumor and target structures. CONCLUSION The described navigation system provided real-time information about the position and orientation of the working instrument in relation to the tumor in an experimental setup. Consequently, it might improve minimally invasive esophagectomy and allow for surgical dissection in an adequate distance to the tumor margin and ease the location of affected lymph nodes.
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Affiliation(s)
- H G Kenngott
- Department of General, Abdominal, and Transplant Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Volfson IA, Munver R, Esposito M, Dakwar G, Hanna M, Stock JA. Robot-Assisted Urologic Surgery: Safety and Feasibility in the Pediatric Population. J Endourol 2007; 21:1315-8. [DOI: 10.1089/end.2007.9982] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Ilya A. Volfson
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Ravi Munver
- Hackensack University Medical Center, Hackensack, New Jersey
- University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - Michael Esposito
- Hackensack University Medical Center, Hackensack, New Jersey
- University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - George Dakwar
- Hackensack University Medical Center, Hackensack, New Jersey
- University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - Moneer Hanna
- Children's Hospital of New Jersey, Newark, New Jersey
| | - Jeffrey A. Stock
- Hackensack University Medical Center, Hackensack, New Jersey
- Children's Hospital of New Jersey, Newark, New Jersey
- University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
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Casula R, Athanasiou T, Foale R. Recent advances in minimal-access cardiac surgery using robotic-enhanced surgical systems. Expert Rev Cardiovasc Ther 2007; 2:589-600. [PMID: 15225118 DOI: 10.1586/14779072.2.4.589] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent advances in interventional cardiology and cardiac surgery have changed traditional therapeutic algorithms by altering indications, timing and patterns of referral for subsequent surgical treatment. Developments in coronary revascularization have focused on reducing both surgical invasiveness and trauma. Patients with significant comorbid pathologies, those undergoing reinterventions and especially the elderly may benefit from such hybrid procedures by avoiding cardiopulmonary bypass and a midline sternotomy. Minimally invasive techniques have revolutionized cardiothoracic surgery by increasing patient satisfaction and by reducing surgical trauma, hospital stay, and consequently overall costs. There are, however, limitations, but robot-assisted surgery endeavors to minimize these technical hindrances and thus allow better and more accurate surgical practice whilst minimizing surgical trauma.
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Affiliation(s)
- Roberto Casula
- Robotic Cardiac Programme, St Mary's Hospital, Praed Street, London W2 1NY, UK.
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Klein MD, Langenburg SE, Kabeer M, Lorincz A, Knight CG. Pediatric Robotic Surgery: Lessons from a Clinical Experience. J Laparoendosc Adv Surg Tech A 2007; 17:265-71. [PMID: 17484664 DOI: 10.1089/lap.2006.0034] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Robotic surgery may improve minimally invasive surgery at high magnification by tremor filtration, motion-scaling, and improved dexterity with the provision of a wrist at the end of the robotic instrument. MATERIALS AND METHODS We chose the Zeus Microwrist robotic surgical system as more applicable to small children than the competing da Vinci surgical system. We attempted 57 surgical procedures and completed 54. RESULTS Completed procedures included Nissen fundoplication (n = 25), cholecystectomy (n = 18), Heller myotomy (n = 2), splenectomy (n = 2), Morgagni hernia repair (n = 2), and single cases of complex pyloroplasty in the chest, bowel resection, left Bochdalek congenital diaphragmatic hernia repair, esophageal atresia and tracheoesophageal fistula repair, and choledochal cyst excision. There were no complications related to the use of the robot. The mean time for the surgeon at the console using the robot was 117 +/- 39 minutes for Nissen fundoplication, and the total operating room time was 250 +/- 60 minutes. Surgeons found dissection, suturing, and knot tying easier than with conventional laparoscopy. None of the surgeons thought the lack of touch feedback (haptics) was crucial. CONCLUSION Robotic surgery offers increased dexterity to the pediatric minimally invasive surgeon, but procedures require more time, and there is no defined patient benefit. The fact that robotic surgery digitalizes minimally invasive surgery creates exciting possibilities for training surgeons, planning operations, and performing surgery at great distances from the operator.
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Affiliation(s)
- Michael D Klein
- Wayne State University School of Medicine and the Maxine and Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program, Children's Hospital of Michigan, Detroit, MI 48201, USA.
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Abstract
Since January 2006, robotic assistance has been used for performing minimal invasive laparoscopic fundoplications in children. These patients were compared with those operated on with either the open surgical technique or the laparoscopic procedure. The first six children operated on with a fundoplication using the operation robot, da Vinci Surgical System from Intuitive Surgical, were included prospectively. As controls, data from the latest six children operated on using the open surgical procedure and the latest six children operated on using the minimal invasive laparoscopic technique were selected retrospectively. All the patients were operated on due to gastroesophageal reflux and were comparable in the De Meester score. The main outcome measures were the operating time, the use of postoperative analgesics, the duration of the postoperative hospital stay and the short-term outcome. There was no significant difference between the three groups concerning age, body weight and preoperative 24 h pH measurement. The mean operating time for the robotic group, 213 min, was the longer one, but the operating time for the latest four patients in the robotic group was similar to that for the laparoscopic group, 189 min. The postoperative hospital stay was shorter and a reduction in the use of analgesics postoperatively was noted. The reduction in the postoperative hospital stay and in the use of analgesics had been already noted with the introduction of the minimal invasive laparoscopic technique. There was no difference in short-term clinical outcome; the gastroesophageal reflux symptoms disappeared in all the patients. Robot-assisted laparoscopic fundoplication is comparable with the standard laparoscopic surgical procedure in terms of duration of operation, postoperative hospital stay, use of postoperative analgesics and short-term clinical outcome. The robotic surgery adds qualities to the surgical work when compared with open or laparoscopic surgery. These include better visualisation for the surgeon and greater precision in the movements of the instruments used.
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Affiliation(s)
- Magnus Anderberg
- Department of Paediatric Surgery, University Hospital, 221 85, Lund, Sweden.
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Abstract
Minimally invasive surgery is rapidly becoming the desired surgical standard,
especially for pediatric patients. Infants and children are a particular technical
challenge, however, because of the small size of target anatomical structures and
the small surgical workspace. Computer-assisted robot-enhanced surgical
telemanipulators may overcome these challenges by facilitating surgery in a small
workspace. We studied the feasibility of performing robotic endoscopic neck surgery
on a porcine model of the human infant neck. The study design was a prospective,
feasibility pilot study of a small cohort for proof of concept and for a survival
model. Sixteen non-survival piglets weighing 4.5–10 kg were used to develop the
surgical approach and operative technique. Eight piglets aged 3–6 weeks old and
weighing 4.0–9.1 kg underwent survival thyroidectomy by a cervical endoscopic
approach using the Zeus surgical robot, which includes the Aesop endoscope holder
and “Microwrist” microdissecting instruments. We succeeded in performing endoscopic
robotic neck surgery on a piglet as small as 4 kg, in an operative pocket as small
as 2 cm3. Total incision length for all three ports was
≤23 mm. There were no major complications, no major robotic instrument malfunctions
or breakages, and no procedures required conversion to open surgery. These results
support the feasibility of robotic endoscopic neck surgery on a neck the size of a
human infant’s.
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Abstract
PURPOSE OF REVIEW Robotic surgery for ureteropelvic junction obstruction is an evolving technique. We review the current literature related to this technique and discuss the current technique and outcomes of robotic pyeloplasty. RECENT FINDINGS Recent advances in robotic-assisted surgery have allowed the successful completion of complex reconstructive procedures in the pediatric population, including the robotic-assisted laparoscopic pyeloplasty. Robotic-assisted laparoscopic pyeloplasty can be performed by either a transperitoneal or a retroperitoneal approach. Overall, the procedure is safe, efficacious, and may have particular benefits over open surgery. SUMMARY The evolution of laparoscopic surgery in pediatric urology has been limited by the challenge of laparoscopic suturing. Robotic systems may offer the means to overcome this major impediment of laparoscopic surgery. The results of this review demonstrate that robotic-assisted laparoscopic pyeloplasty is safe, technically feasible, and efficacious in the pediatric population, and may be comparable to a contemporary series of open pyeloplasty. As the technology continues to evolve, the efficiency of the robotic system is likely to improve; however, the ultimate role of robotic-assisted or computer-assisted surgical systems remains unclear. To further determine the role of robotic systems in the management of ureteropelvic junction obstruction, rigorous prospective research is needed that combines surgical and technical outcomes with overall subjective or cosmetic outcome and economic analysis.
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Affiliation(s)
- Richard S Lee
- Department of Urology, Children's Hospital Boston, MA 02115, USA
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Chandra V, Dutta S, Albanese CT. Surgical robotics and image guided therapy in pediatric surgery: emerging and converging minimal access technologies. Semin Pediatr Surg 2006; 15:267-75. [PMID: 17055957 DOI: 10.1053/j.sempedsurg.2006.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Minimal access surgery (MAS) is now commonplace in the armamentarium of the pediatric surgeon, and is being applied to a growing list of pediatric surgical diseases. Robot-assisted surgery and image guided therapy (IGT) have evolved as innovative minimal access approaches, and hold the promise of advancing MAS far beyond what is currently possible. The aims of this article are to describe the currently available robotic, and image guided therapy systems, review their present and potential applications, and discuss the future directions of these converging technologies.
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Affiliation(s)
- Venita Chandra
- Stanford University School of Medicine, Stanford, California 94305, USA
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Lehnert M, Richter B, Beyer PA, Heller K. A prospective study comparing operative time in conventional laparoscopic and robotically assisted Thal semifundoplication in children. J Pediatr Surg 2006; 41:1392-6. [PMID: 16863843 DOI: 10.1016/j.jpedsurg.2006.04.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is not clear if robotically assisted surgery (providing articulating instruments, 3-dimensional vision, intuitive ergonomics) performed in pediatric patients offers the same advantages over conventional surgery as in adult patients. In the laboratory setting, robots require less time to perform certain tasks. Accordingly, we tested the hypothesis that the time required to perform a robotically assisted laparoscopic Thal semifundoplication is different compared with a conventional laparoscopic procedure in children. METHODS The time required to perform single operative steps was prospectively recorded in 10 consecutively performed Thal semifundoplications with the use of a robot (da Vinci) and in 10 consecutively performed operations done by conventional laparoscopy. RESULTS No conversion to an open operation was necessary, and there were no intraoperative complications throughout the study and no postoperative complications up to 14 months after surgery. Total operative time was similar in both groups. In the robotically assisted group, time for setup was significantly longer (20.8 +/- 7.5 vs 34.6 +/- 9.2 minutes, P < .05), but dissection of the hiatal region as the most challenging operative step was accomplished 34% faster in the robotically assisted group (30.8 +/- 8.7 vs 20.2 +/- 5.3 minutes, P < .05). CONCLUSION At the current level of technology, the robotic system is superior compared with established standard laparoscopic techniques requiring tissue preparation; however, the potential benefit in operating time is counterbalanced by the increased complexity of setting up the system.
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Affiliation(s)
- Mark Lehnert
- Department of General and Vascular Surgery, Division of Pediatric Surgery, J.W. Goethe University, 60596 Frankfurt am Main, Germany
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Affiliation(s)
- Bindi Naik-Mathuria
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin CC 650.00, Houston, TX 77030-2399, USA
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Lee RS, Retik AB, Borer JG, Peters CA. Pediatric Robot Assisted Laparoscopic Dismembered Pyeloplasty: Comparison With a Cohort of Open Surgery. J Urol 2006; 175:683-7; discussion 687. [PMID: 16407025 DOI: 10.1016/s0022-5347(05)00183-7] [Citation(s) in RCA: 213] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Indexed: 11/26/2022]
Abstract
PURPOSE We assessed the usefulness of RALP in children and compared an age matched cohort undergoing OPN to RALP for safety, efficacy, operative time, blood loss, in-hospital narcotic use and LOS. MATERIALS AND METHODS We performed a retrospective case-control study from 2000 to 2004 of 33 patients undergoing RALP and 33 undergoing OPN. Average age of each group was not significantly different (RALP 7.8 years vs OPN 7.6 years, p = 0.75). Mean followup of RALP and OPN groups was 10 and 21 months, respectively. RESULTS Etiology of the obstruction was not significantly different. Mean operative time was significantly less for OPN (181 minutes vs 219 minutes for RALP, p = 0.031). As RALP experience increased, operative times improved and approached the OPN experience. RALP complications included 1 patient requiring reoperative surgery vs no complications in the OPN group (p = 0.15). Patients undergoing RALP had a mean LOS of 2.3 days compared to 3.5 days for OPN (p <0.001). Total narcotic requirements were significantly less in the RALP group (p = 0.001). All patients in the OPN and 31 in the RALP group had either resolution of hydronephrosis, improvement in drainage or relief of symptoms. CONCLUSIONS We documented the safety and efficacy of RALP in children. RALP showed advantages of decreased hospital stay, decreased narcotic use and operative times approaching those of open surgery. RALP is an option for pyeloplasty, and as robotic technology improves, this method of repair may become the minimally invasive treatment of choice.
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Affiliation(s)
- Richard S Lee
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA
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Meininger D, Byhahn C, Mierdl S, Lehnert M, Heller K, Zwissler B, Bremerich DH. Hemodynamic and respiratory effects of robot-assisted laparoscopic fundoplication in children. World J Surg 2005; 29:615-9; discussion 620. [PMID: 15827850 DOI: 10.1007/s00268-005-7695-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Laparoscopic fundoplication is increasingly used for treating gastro-esophageal reflux disease in children. Mechanical and pharmacological effects may contribute to hemodynamic and respiratory changes during carbon dioxide pneumoperitoneum. The aim of the present study was to evaluate the hemodynamic and respiratory effects of pneumoperitoneum (PP) with an intra-abdominal pressure (IAP) of 12 mmHg in children undergoing robot-assisted laparoscopic fundoplication during total intravenous anesthesia. Ten children, aged 8-16 years, American Society of Anesthesiologists physical status II-III, scheduled for robot-assisted laparoscopic fundoplication in the reverse Trendelenburg position were investigated. Minute ventilation (MV), peak inspiratory pressure (PIP), IAP, heart rate (HR), mean arterial blood pressure (MAP) were recorded, together with pH, base excess, HCO3-, P(et)CO2, PaCO2, and PaO2 at six time points: before insufflation, 10, 30, 60, 90 minutes after creating PP and after desufflation. The IAP was maintained at 12 mmHg. During insufflation MAP increased significantly from 70.6 (+/-9.0) to 84.8 (+/-10.4) mmHg, MV was increased from 4.6 (+/-0.8) to 5.5 (+/-0.9) l min(-1), PIP increased, PaO2 and pH decreased. P(et)CO2 increased from 33.1 (+/-1.6) to 36.6 (+/-1.6) mmHg together with PaCO2. Hemodynamic and respiratory effects due to the intra-abdominal insufflation of CO2 with an IAP of 12 mmHg are well tolerated, and anesthesia with remifentanil, propofol and mivacurium facilitates extubation immediately at the end of surgery.
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Affiliation(s)
- Dirk Meininger
- Department of Anesthesiology, Intensive Care Medicine and Pain Control, J.W. Goethe-University Hospital, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany.
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Abstract
Computer-enhanced robotic surgical systems have been increasingly used to facilitate complex minimal access surgical procedures. In adult patients, such systems have been used to perform a wide variety of operations including coronary artery bypass grafting, mitral valve repair, Roux-en-Y gastric bypass, colon resection, nephrectomy, and radical prostatectomy. In the field of pediatric surgery, the experience with robotic surgical systems has been more limited. However, with improvements in robotic technology, interest and experience with robotic pediatric surgery have grown rapidly. The purpose of this article is to review the current experimental and clinical literature regarding the use of robotic surgical systems in the pediatric patient population.
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Affiliation(s)
- Russell Woo
- Department of Surgery, Stanford University Medical Center, 780 Welch Road, Suite 206, Stanford, California 94305-5733, USA
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Lorincz A, Knight CG, Langenburg SE, Rabah R, Gidell K, Dawe E, Grant S, Klein MD. Robot-assisted minimally invasive Kasai portoenterostomy: a survival porcine study. Surg Endosc 2004; 18:1136-9. [PMID: 15156391 DOI: 10.1007/s00464-003-8259-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Accepted: 02/19/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Major enhancements offered by robotic surgery for minimally invasive procedure include tremor filtration, motion scaling, and the addition of a wrist to the instrument. Minor enhancements include indexing as well as safe and rapid instrument exchange. A benefit associated with any endoscopic procedure is magnification. It was hypothesized that these enhancements would allow the performance of complex gastrointestinal surgery. METHODS Eight survival pigs (weight, 2.5-8 kg) underwent a robotically assisted minimally invasive portoenterostomy. The procedure was analogous to the Kasai portoenterostomy for biliary atresia usually performed for human patients at the age of 4 to 12 weeks. RESULTS Five of the eight animals survived for more than 1 month after the operation, returning to normal eating and bowel habits in 2 to 3 days. None were jaundiced. All laboratory values were normal. At 1 month, the animals were killed. There was no anastomotic stenosis at either the end-to-side enteroenterostomy or the portoenterostomy. Histologically, the anastomoses were well healed. CONCLUSION Computer-assisted robot-enhanced technology allows complex gastrointestinal surgery to be performed using minimally invasive techniques.
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Affiliation(s)
- A Lorincz
- Department of Surgery, Wayne State University School of Medicine and Children's Hospital of Michigan, Children's Research Center of Michigan, Detroit, MI 48201, USA
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Luebbe BN, Woo R, Wolf SA, Irish MS. Robotically Assisted Minimally Invasive Surgery in a Pediatric Population: Initial Experience, Technical Considerations, and Description of the da Vinci® Surgical System. ACTA ACUST UNITED AC 2003. [DOI: 10.1089/109264103322614268] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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