Robot-assisted appendectomy in a child — a case report

Abstract

BACKGROUND: Acute appendicitis is the most common surgical pathology requiring emergency intervention in children worldwide. The gold standard in the treatment of the disease is laparoscopic appendectomy. At the same time, advances in technology increasingly incline specialists to the introduction of robotic systems in surgical practice. This fact once again confirms the importance of research aimed at determining the feasibility of using robot-assisted appendectomy in emergency surgery in children.

CLINICAL CASE DESCRIPTION: The authors made a retrospective review of the medical history of a child with acute appendicitis. A 11-year-old boy was admitted to the Irkutsk State Regional Children's Clinical Hospital with abdominal pain in the right iliac region. At the time of admission, disease duration was 20 hours. For surgery, the Versius robot manufactured by CMR company (UK) was used. Robot-assisted appendectomy followed the same principles as those used in open or laparoscopic approaches: (1) appendix exposure, (2) mesoappendix bipolar coagulation, (3) appendix removal using an endoscopic mechanical stapler.

The total surgical time was 30 minutes, out of which the robot installation time was 10 minutes and the main console time was 20 minutes. The entire procedure was performed completely intracorporally and without conversion to laparoscopic or open surgery. There were no any intraoperative problems and complications. The surgery was successful. Patient’s enteral feeding started on the same day after the surgery. He was discharged from the hospital on Day 3 day after the surgery. Ultrasound of the abdominal cavity, performed 1 month later, did not reveal any signs of abnormalities observed at this age. The patient did not complain of any digestive problems during the entire observation period for 3 months after the surgery.

CONCLUSION: Robotic appendectomy has its advantages and disadvantages in the treatment of acute appendicitis. Robotics provides faster postoperative recovery of patients, but requires longer time for surgery; besides, it is an expensive surgical intervention. However, over time the robot-assisted appendectomy may become a cost-effective one that will be successfully used by all surgeons, as it happened with laparoscopic appendectomy several decades ago.

Keywords

robot-assisted surgery / acute appendicitis / children

References

[1] Rey R, Gualtieri R, La Scala G, Posfay Barbe K. Artificial Intelligence in the Diagnosis and Management of Appendicitis in Pediatric Departments: A Systematic Review. Eur J Pediatr Surg. 2024;34(5):385–391. doi: 10.1055/a-2257-5122

[2] Lee WH, O’Brien S, McKinnon E, et al. Study of pediatric appendicitis scores and management strategies: A prospective observational feasibility study. Acad Emerg Med. 2024;31(11):1089–1099. doi: 10.1111/acem.14985

[3] Froehlich M, Karunungan K, Jen HC, et al. Non-Operative Management of Uncomplicated Appendicitis in Children: Can Patients Be Discharged From the Emergency Department? J Pediatr Surg. 2024:161643. doi: 10.1016/j.jpedsurg.2024.07.028

[4] Adams SE, Perera MRS, Fung S, et al. Non-operative management of uncomplicated appendicitis in children: a randomized, controlled, non-inferiority study evaluating safety and efficacy. ANZ J Surg. 2024;94(9):1569–1577. doi: 10.1111/ans.19119

[5] Reddy S, Tote D, Zade A, et al. Comparative Analysis of Robotic-Assisted Versus Laparoscopic Appendectomy: A Review Cureus. 2024;16(6):e63488. doi: 10.7759/cureus.63488

[6] Orcutt ST, Anaya DA, Malafa M. Minimally invasive appendectomy for resection of appendiceal mucocele: Case series and review of the literature. Int J Surg Case Rep. 2017;37:13–16. doi: 10.1016/j.ijscr.2017.05.027

[7] Arang H, El Boghdady M. Robotic Appendicectomy: A review of feasibility. Sultan Qaboos Univ Med J. 2023;23(4):440–446. doi: 10.18295/squmj.7.2023.043

[8] Alqahtani A, Albassam A, Zamakhshary M, et al. Robot-assisted pediatric surgery: how far can we go? World J Surg. 2010;34(5):975–978. doi: 10.1007/s00268-010-0431-6

[9] Bütter A, Merritt N, Dave S. Establishing a pediatric robotic surgery program in Canada. J Robot Surg. 2017;11(2):207–210. doi: 10.1007/s11701-016-0646-0

[10] Becker T, DeLeon G, Rao V, Pei KY. A comparison of outcomes between laparoscopic and robotic appendectomy among ACS-NSQIP hospitals. Laparosc Endosc Robot Surg. 2023, 6:39–42. doi: 10.1016/j.lers.2023.04.003

[11] Alemzadeh H, Raman J, Leveson N, et al. Adverse Events in Robotic Surgery: A Retrospective Study of 14 Years of FDA Data. PLoS One. 2016;11(4):e0151470. doi: 10.1371/journal.pone.0151470

[12] Shen LT, Tou J. Application and prospects of robotic surgery in children: a scoping review. World J Pediatr Surg. 2022;5(4):e000482. doi: 10.1136/wjps-2022-000482

[13] Mei H, Tang S. Robotic-assisted surgery in the pediatric surgeons’ world: Current situation and future prospectives. Front Pediatr. 2023;11:1120831. doi: 10.3389/fped.2023.1120831

[14] Lunardi N, Abou-Zamzam A, Florecki KL, et al. Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery. JAMA Surg. 2024;159(5):493–499. doi: 10.1001/jamasurg.2024.0016

[15] Myla K, Bou-Ayash N, Kim WC, et al. Is implementation of robotic-assisted procedures in acute care general surgery cost-effective? J Robot Surg. 2024;18(1):223. doi: 10.1007/s11701-024-01912-y

[16] Rifai AO, Rembetski EM, Stutts LC, et al. Retrospective analysis of operative time and time to discharge for laparoscopic vs robotic approaches to appendectomy and cholecystectomy. J Robot Surg. 2023;17(5):2187–2193. doi: 10.1007/s11701-023-01632-9

[17] Akl MN, Magrina JF, Kho RM, Magtibay PM. Robotic appendectomy in gynaecological surgery: technique and pathological findings. Int J Med Robot. 2008;4(3):210–213. doi: 10.1002/rcs.198

[18] Kelkar D, Borse MA, Godbole GP, et al. Interim safety analysis of the first-in-human clinical trial of the Versius surgical system, a new robot-assisted device for use in minimal access surgery. Surg Endosc. 2021;35(9):5193–5202. doi: 10.1007/s00464-020-08014-4

RIGHTS & PERMISSIONS

Eco-Vector