Thoracic surgery by minimally invasion robot-assisted in children: “experience and current status”

Abstract

Aim: We report our experience in minimally invasive thoracic robot-assisted surgery in children, and a current analysis is carried out on this topic.

Methods: Observational, prospective, and longitudinal studies were performed for children with thoracic pathology treated with robotic surgery, from March 2015 to April 2019. We used the “da Vinci surgical system” (Intuitive Surgical, Inc., Sunnyvale, CA. USA). Registered variables included demographic data, diagnosis, surgery, total time, time of console surgery, bleeding, hemotransfusions, conversions, complications, postoperative (PO) stay, and follow-up. Measures of central tendency were used. Research Ethics Committee of Hospital approved the study. We conducted a detailed non-systematic review of previous publications of children undergoing thoracic robotic surgery.

Results: We treated 11 children, with average age of 5.7 years and weight of 21.3 kg. Diagnosis were: congenital cystic adenomatoid malformation, intralobar sequestration, diaphragmatic paralysis, diaphragmatic eventration, mediastinal teratoma, Ewing’s tumor of the fourth left rib, and pulmonary tuberculosis. Surgeries performed were: four lobectomies, four diaphragmatic plications, two tumor resections, and a case of pleural and lung biopsies. The average of console surgery time was 166.45 min, PO stay was 3.6 days, and follow-up was 24.7 months. Conversions and PO complications were 9.1%, and there were no intraoperative complications and mortality. Currently, the number of children treated with thoracic robot-assisted surgery has barely reached 100 cases.

Conclusion: Our results are encouraging, although our experience is limited to a few cases. Robotic surgery for the treatment of thoracic pathology is feasible and safe, and has advantages. To date, very few patients have been treated, and few pediatric surgeons worldwide have applied thoracic robotic surgery in children.

Keywords

Robotic surgery / thoracic surgery / thoracic robotic surgery / thoracoscopy / congenital malformations / children

References

[1] Ure B.Enthusiasm, evidence and ethics: the triple E of minimally invasive pediatric surgery..J Pediatr Surg2013;48:27-33

[2] Klimkovich IG,Okulov AB,Poliakova ON.Thoracoscopy in children..Khirurgiia (Mosk)1971;47:19-24

[3] Rodgers BM,Talbert JL.Thoracoscopy in children..Ann Surg1979;189:176-80 PMCID:PMC1397035

[4] Rodgers BM.Thoracoscopy in children..Poumon Coeur1981;37:301-6

[5] Makita S,Ono Y.Risk factors for thoracic and spinal deformities following lung resection in neonates, infants, and children..Surg Today2017;47:810-14 PMCID:PMC5486598

[6] Park S,Hwang Y,Park IK.Serial improvement of quality metrics in pediatric thoracoscopic lobectomy for congenital lung malformation: an analysis of learning curve..Surg Endosc2017;31:3932-8

[7] Zhang J,Xu C,Li F.Clinical report of 128 cases of meticulous thoracoscopic lobectomy in children..Sichuan Da Xue Xue Bao Yi Xue Ban2018;49:474-7(in Chinese)

[8] Clermidi P,Skhiri A,Vitoux C.Fast track pediatric thoracic surgery: toward day-case surgery?.J Pediatr Surg2017;52:1800-5

[9] Melfi FM,Mariani AM.Early experience with robotic technology for thoracoscopic surgery..Eur J Cardiothorac Surg2002;21:864-8

[10] Ashton Jr RC,Swistel DG.Robot-assisted lobectomy..J Thorac Cardiovasc Surg2003;126:292-3

[11] Park BJ,Rusch VW.Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results..J Thorac Cardiovasc Surg2006;131:54-9

[12] Toker A.Robotic thoracic surgery: from the perspectives of European chest surgeons..J Thorac Dis2014;6:S211-6 PMCID:PMC4032961

[13] Medical Advisory SecretariatRobotic-assisted minimally invasive surgery for gynecologic and urologic oncology: an evidence-based analysis..Ont Health Technol Assess Ser2010;10:1-118 PMCID:PMC3382308

[14] Woo R,Albanese CT.Robot-assisted laparoscopic resection of a type I choledochal cyst in a child..J Laparoendosc Adv Surg Tech A2006;16:179-83

[15] Adams RD,Stephenson JE,Robbins ET.Initial multicenter community robotic lobectomy experience: comparisons to a national database..Ann Thorac Surg2014;97:1893-8

[16] Melfi FM,Davini F,Lucchi M.Robotic lobectomy for lung cancer: evolution in technique and technology..Eur J Cardiothorac Surg2014;46:626-30

[17] Seong YW,Choi JW,Jeon JH.Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: its superiority over a conventional sternotomy approach evaluated by propensity score matching..Eur J Cardiothorac Surg2014;45:e68-73

[18] Meininger DD,Heller K,Westphal K.Totally endoscopic Nissen fundoplication with a robotic system in a child..Surg Endosc2001;15:1360

[19] van Haasteren G,Hayes W.Pediatric robotic surgery: early assessment..Pediatrics2009;124:1642-9

[20] Le Bret E,Folliguet T,Pétrie J.Interruption of patent ductus arteriosus in childre: Robotically assisted versus videothoracoscopic surgery..J Thorac Cardiovasc Surg2002;123:973-6

[21] Ohye RG,Graziano J.Amplatzer closure of atrial septal defect and da Vinci robot-assisted repair of vascular ring..Pediatr Cardiol2004;25:548-51

[22] Ballouhey Q,Cros J,Bérenguer D.Assessment of paediatric thoracic robotic surgery..Interact Cardiovasc Thorac Surg2015;20:300-3

[23] Navarrete-Arellano M.Robot-assisted laparoscopic and thoracoscopic surgery: prospective series of 186 pediatric surgeries..Front Pediatr2019;7:200 PMCID:PMC6537604

[24] Clavien PA,de Oliveira ML,Dindo D.The Clavien-Dindo classification of surgical complications: five-year experience..Ann Surg2009;250:187-96

[25] Mihaljevic T,del Nido PJ.Robotically assisted division of a vascular ring in children..J Thorac Cardiovasc Surg2003;125:1163-4

[26] de Lambert G,Centi J,Braik K.How to successfully implement a robotic pediatric surgery program: lessons learned after 96 procedures..Surg Endosc2013;27:2137-44

[27] Meehan JJ.Pediatric robotic surgery: a single-institutional review of the first 100 consecutive cases..Surg Endosc2008;22:177-82

[28] Hartwich J,Margaron F,Teasley J.Robot-assisted thoracoscopic thymectomy for treating myasthenia gravis in children..J Laparoendosc Adv Surg Tech A2012;22:925-9

[29] Della Marina A,Müllers M,Ismail M.Outcome after robotic-assisted thymectomy in children and adolescents with acetylcholine receptor antibody-positive juvenile myasthenia gravis..Neuropediatrics2017;48:315-22

[30] Kamran A,Zendejas B,Jennings RW.Minimally invasive surgical approach for posterior tracheopexy to treat severe tracheomalacia: lessons learned from initial case series..J Laparoendosc Adv Surg Tech A2018;28:1525-30

[31] DeUgarte DA,Hirschl RB.Robotic extirpation of complex massive esophageal leiomyoma..J Laparoendosc Adv Surg Tech A2008;18:286-9

[32] Toker A,Grusina-Ujumaza J.Resection of a bronchogenic cyst in the first decade of life with robotic surgery..Interact Cardiovasc Thorac Surg2014;19:321-3

[33] Asaf BB,Vijay CL.Robotic excision of paraesophageal bronchogenic cyst in a 9-year-old child..J Indian Assoc Pediatr Surg2015;20:191-3 PMCID:PMC4586983

[34] Cundy TP,Clark J,Sriskandarajah K.The first decade of robotic surgery in children..J Pediatr Surg2013;48:858-86

[35] Navarrete-Arellano M.Experience in the Treatment of Choledochal Cyst with Robot-Assisted Surgery in Children: and “The Current State of Minimally Invasive Surgery in this Anomaly’”..Acta Scientific Paediatrics2019;2:4-13

[36] Meehan JJ.Robotic resection of mediastinal masses in children..J Laparoendosc Adv Surg Tech A2008;18:114-9

[37] Samadi D,Hakimi A,Benson MC.From proficiency to expert, when does the learning curve for robotic-assisted prostatectomies plateau? The Columbia University experience..World J Urol2006;25:105-10

[38] Meehan JJ.The learning curve associated with laparoscopic antireflux surgery in infants and children..J Pediatr Surg1997;32:426-9

[39] Obasi PC,Varela JC.Excision of esophageal duplication cysts with robotic-assisted thoracoscopic surgery..SLS2011;15:244-7 PMCID:PMC3148881

[40] Rückert JC,Ismail M.Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study..J Thorac Cardiovasc Surg2011;141:673-7

[41] Rodriguez M,Howard FM.Myasthenia gravis in children: long-term follow-up..Ann Neurol1983;13:504-10

[42] Castro D,Anderson M,Iannaccone S.Juvenile myasthenia gravis: a twenty-year experience..J Clin Neuromuscul Dis2013;14:95-102

[43] Kamran A,Zendejas B,Jennings RW.Minimally invasive surgical approach for posterior tracheopexy to treat severe tracheomalacia: lessons learned from initial case series..J Laparoendosc Adv Surg Tech A2018;28:1525-30

[44] Yamaguchi Y,Burrier C.Point-of-care lung ultrasound to evaluate lung isolation during one-lung ventilation in children: a case report..Saudi J Anaesth2019;13:243-45 PMCID:PMC6625300

[45] Slater BJ.Robotic repair of congenital diaphragmatic anomalies..J Laparoendosc Adv Surg Tech A.2009;19 Suppl 1:S123-7

[46] Szavay PO,Blumenstock G,Luithle T.Perioperative outcome of patients with esophageal atresia and tracheo-esophageal fistula undergoing open versus thoracoscopic surgery..J Laparoendosc Adv Surg Tech A2011;21:439-43

[47] Rothenberg SS.Experience with thoracoscopic repair of long gap esophageal atresia in neonates..J Laparoendosc Adv Surg Tech A2015;25:932-5

[48] de Lijster MS,van Dalen EC,Caron HN.Minimally invasive surgery versus open surgery for the treatment of solid abdominal and thoracic neoplasms in children..Cochrane Database Syst Rev2012;18:1:CD008403

[49] Sato T,Fukuzawa T,Sasaki H.Mediastinal tumor resection via open or video-assisted surgery in 31 pediatric cases: experiences at a single institution..J Pediatr Surg2016;51:530-3

[50] Fraga JC,Kiely E.Video-assisted thoracic surgery resection for pediatric mediastinal neurogenic tumors..J Pediatr Surg2012;47:1349-53

[51] Irtan S,Minard-Colin V,Canale S.Minimally invasive surgery of neuroblastic tumors in children: Indications depend on anatomical location and image-defined risk factors..Pediatr Blood Cancer2015;62:257-61