Implementation of robotic systems in paediatric craniofacial and head and neck surgery: a narrative review of the literature

Surgical challenges in paediatric craniofacial and head and neck surgery can include operating in a small cavity, limited depth perception, restricted access with difficult angulations, and poor visualisation. Delicate tissue handling, muscle dissection, and suturing at depth require surgical access in congruence with the use of operative microscopes. Robotic assistance may aid surgeons in operating in confined spaces with minimal access incisions by improving the degree of freedom of operative instrumentation. In this study, we aim to review the use of robotic systems in paediatric head and neck and craniofacial surgery by focussing on total complications and length of surgery together with patient and surgeon experience. A literature search was conducted in June 2023 by two independent reviewers on Pubmed, Dynamed, DARE, EMBASE, Cochrane and British Medical Journal (BMJ) electronic databases for articles published between 1960-2024. Seventeen papers met the inclusion criteria. Seventy-nine patients were included. The success rate for head and neck and craniofacial cases that included robotic-assistance was 93.7% (n = 74) and the complication rate was 16.0% (n = 12). Robotic-assisted surgery demonstrates a low complication rate in treating a range of different pathologies in the head and neck in our included studies. Robotic-assistance in craniofacial surgery demonstrates promise in preventing iatrogenic injury from more traditional methods, and could allow for operations to proceed earlier in life in the management of midface distraction, however, more research in the area is necessary with limited research published at present.