Introduction
The procedure involving endoscopic surgeries for children has been in use since the 1970s. This started when the focus on minimally invasive procedures was approached. Since then, many endoscopic procedures have been introduced, and doctors are being trained. There are a lot of advantages to these procedures.
The invention of robotic surgery has increased and extended surgeons' capabilities, addressed the difficulties, and reduced morbidity associated with routine endoscopic procedures. This introduction of robotic surgeries has improved the reconstructive surgical skills of doctors because of the advantages of refined motor skills provided by robots' procedures. They have improved vision, are tremor-free, and have high-depth perception. Meninger performed the first pediatric robotic case. Recently, with the increase in robotic surgeries in pediatrics, several procedures in children have been carried out laparoscopically using robots.
Why Are the Special Considerations in Pediatric Procedures?
In pediatrics, the approach, including robotic surgeries, is similar to that of adults. In pediatrics, there are certain unique considerations. As the working space in children is limited, the wall of the abdomen is thinner, and it is important to position the parts correctly. There can be 8 - 10 cm between the two ports in adults, but in pediatric procedures, this is impossible because of the smaller body size. These ports create a symmetrical array near and around the camera port to reach the site of interest. In children, the smaller body size makes the working area smaller, posing a greater risk of injury to the viscera with the use of ports and instruments. For this reason, the procedure of carried or under direct vision is used for the correct placement of each port and course of the placed instrument.
Especially for pediatrics, smaller instrument areas are made with a diameter of approx 5mm. In adults, the usual diameter of the instruments used is around 8mm. The instrument and wrist have a 5mm diameter included with it as b needle holder, grasper, scissors ultrasonic energy instrument, and reusable accessories. For pediatrics, if the diameter is smaller, the instrument requires a longer distance to facilitate the required angle. 2D and 3D endoscopes were also developed to facilitate endoscopic procedures in pediatric patients.
What Are the Advantages and Disadvantages of Robotics in Pediatric Patients?
Many advantages are associated with robotic surgeries in pediatric procedures. Those include
Advantages
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The benefits of patient recovery are the same as those of other minimally invasive procedures, such as less operative trauma, less post-operative pain, reduced need for post-operative painkillers, decreased hospital stay, improved cosmetics, and quick return to work or school.
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It supersedes the advantages of laparoscopic surgeries by its precision and design.
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Eliminates the instrument constraints for the procedures.
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The flexibility of instruments improves dexterity, which is essential for smaller areas of the body in infants and newborns.
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Better visualizations with the help of magnified 3 dimension imaging as compared to traditional endoscopes and laparoscopies.
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Images can be magnified 10 to 15 times for better perception and control.
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Surgeons are physically separate from the patient's bedside and can also perform surgeries in other parts of countries.
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Limited complications in ontological procedure with better efficiency.
Disadvantages
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The robotic instruments are still larger with 5mm diameter than instruments with 2mm as used in traditional procedures.
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The TransEnterix system using a 3-millimeter diameter instrument is not used in pediatrics as it is not currently approved for pediatric use.
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The surgeon should be highly trained and able to conduct the surgeries to the best of their ability.
What Are the Applications of Robotics in Pediatric Surgeries?
Robotics are currently being used in almost all the procedures in the pediatric department.
1. Urology
Urologic procedures are the most common application of robotic surgeries. Pyeloplasty is performed with robotics and is the first robotic-assisted surgery done in pediatrics. This has all the benefits of transitional surgeries with the benefits of 3D visualization. Urethral reimplantation is the second most common procedure that is robotically assisted. Partial or even complete nephrectomy are used in benign malignancies in collagen. However, these procedures are only sometimes performed.
2. General thoracic surgery
There are a few procedures that are carried out with robotic technology. Fundoplication is usually performed with robotic assistance in pediatrics.
3. Cyst resection
Cyst resection is done in pediatrics with the help of robotic assistance. However, the patients are usually older than small children who are chosen for robotic cyst resection.
4. Otolaryngology
Removal of tongue base masses is carried out with robotics. The mortality rate has reduced significantly. Resection of malignant tumors, tonsillectomy, thyroglossal duct cyst removal, and repair of laryngeal cleft and vocal cord paralysis is carried out with robotics.
5. Oncology
Minimally invasive surgeries are approved for robotics. These have increased advantages of less pain, reduced hospitalization and post-operative full mobilization, and reduced risk of wound bleeding.
Is Robotic Surgery Safe in Pediatrics?
The safety procedures for robotic procedures are the same for adults and children. However, pediatric patients require special consideration. Most of these are the same as traditional procedures. Positioning in children is important compared to adults because of the smaller body size area. Hyperextension and flexion are to be taken extra care of. special considerations should be given to positioning, skin protection, and securing children to the table.
Special anesthetic consideration is given to the children. Robotics usually require Trendelenburg position in children for extra care.
Conclusion
Robotic-assisted surgeries in pediatrics are safe, and results are effective in children. The procedures that are being performed robotically are expanding and increasing recently. More studies are needed to assess the actual benefits of robotics as compared to traditional pediatric procedures. As the smaller size of instruments used in robotics gets invented, the use of robotic procedures in pediatric procedures will surely increase. Training programs, clinical training, selection of cases, and cost analysis are to be considered and improved to facilitate and increase the use of robotics in pediatric surgeries on a larger scale with successful outcomes and more benefits.
