A. Mina1, M. W. Wallace2, A. D. Patel1, B. Hopkins3, K. Idrees4, M. C. Duke5, S. L. McChesney3, A. Khan3, J. C. Thomas6, J. S. Upperman1, G. P. Jackson7, I. J. Zamora1 2Vanderbilt University Medical Center, Department Of Pediatric Surgery, Nashville, TN, USA 1Vanderbilt University, School Of Medicine, Nashville, TN, USA 3Vanderbilt University Medical Center, Division Of General Surgery, Section Of Colon & Rectal Surgery, Nashville, TN, USA 4Vanderbilt University Medical Center, Division Of Surgical Oncology And Endocrine Surgery, Nashville, TN, USA 5Vanderbilt University Medical Center, Division Of General Surgery, Nashville, TN, USA 6Vanderbilt University Medical Center, Division Of Pediatric Urology, Nashville, TN, USA 7Vanderbilt University Medical Center, Departments Of Surgery, Pediatrics And Biomedical Informatics, Nashville, TN, USA
Introduction: Minimally invasive surgery has been revolutionized by the introduction of robotic surgery, which offers multiple advantages over laparoscopic techniques. These include stabilized 3D visualization, motion scaling, wristed instruments, improved operative ergonomics, and built-in Near-infrared fluorescent imaging technology. Despite this, robotic surgery has been slow to be adapted in pediatric surgery. Due to the intricacy of pediatric anatomy and the confined operative fields encountered, pediatric surgery may reap significant benefit from this technology. Here we present our experience with the successful development of a complex robotic general surgery program at a pediatric referral center. This involved a purposeful tiered progression of case difficulty and close collaboration between a pediatric surgeon and colorectal, surgical oncology, and minimally invasive surgeons from our adult robotic surgery program.
Methods: The program was developed over a 2-year period, including 14 months of systems development and training, followed by 10 months of operative experience. Education on the basics of robotic surgery was obtained through the operative robot manufacturer. Through collaboration between a pediatric surgeon and adult subspecialists, a tiered case progression was employed, facilitating familiarity with core robotic surgical techniques and technologies such as the use of indocyanine green (ICG), prior to advancing in surgical complexity. With this, our program advanced from routine procedures such as cholecystectomies to more complex procedures such as paraesophageal hernia repair, hemicolectomies, anterior mesh rectopexy and a spleen-preserving distal pancreatectomy.
Results: In total, 24 robotic surgeries were performed in a 10-month period. Sequentially, this included a tiered-progression of case difficulty beginning with 18 cholecystectomies followed by 2 segmental colectomies, 1 paraesophageal hernia repair, 1 anterior mesh rectopexy, 1 paraesophageal hernia repair and 1 spleen-preserving distal pancreatectomy. Procedure duration ranged from 58 minutes to 207 minutes. There was a small pancreatic leak in the distal pancreatectomy patient, which was easily managed with an intraoperative drain. Otherwise, there were no major perioperative adverse events.
Conclusion: Robotic surgery has the potential to revolutionize the field of pediatric minimally invasive surgery. Our center’s experience demonstrates the feasibility and safety of employing robotic surgical techniques in the field of pediatric general surgery. This experience emphasizes the importance of stepwise introduction of robotic technology with increasing operative difficulty and collaboration with experts in adult robotic surgery.
