Robotic surgery in newborns and infants under 12-months: Is it feasible?

Introduction

Robotic surgery in pediatric patients has some difficulties compared to adults, such as reduced cavities due to children's small size that lead to decreased working space. This limitation has restricted this type of approach in newborn and infant patients. We present a retrospective review of our first 100 consecutive robotic cases in children under 12-months

Methods

A retrospective single-center study was performed among consecutive children under 12-months who underwent robotic surgeries between 2010 and 2020. A three-arm robot (5-mm trocars) with one 12-mm camera arm was used. Demographic data, type of robotic procedure, surgery time and postoperative complications were analyzed.

Results

A total of 100 patients were included (51 males; 49 females), with a median age of 5 months at surgery (IQR: 3–8 months) and a mean weight of 6.2 ± 1.9 kg. We performed 147 robotic-assisted procedures: 66 fundoplications, 43 gastrostomies, 19 pull-throughs, 8 pyloroplasties, 3 congenital diaphragmatic hernia repairs, 2 nephrectomies, 1 adrenal tumor, 1 liver cyst, 1 mediastinal cyst, 1 common bile duct cyst, 1 intestinal duplication cyst and 1 Ladd's procedure. Median surgery time was 130 min with some differences among different procedures (IQR: 103–202 min). No intraoperative complications or conversion to open or laparoscopic technique were described. Postoperative complications were found in 6 patients (2 required reoperation). During long-term follow-up (median 6.5 years; IQR 3.8–9.4), we reported 4 % of reintervention.

Conclusion

Although robotic surgery in newborns and infants are still controversial, it is feasible and safe to perform by well-trained surgeons, with a very low complication rate.

Level of evidence

IV.