Robot-assisted Minimally Invasive Thoracic Surgery in Children: "Experience and Current Scenario"

Aim: The objective of this chapter is to inform about our experience in minimally invasive thoracic surgery (MITS) assisted by robot in children. In addition, an analysis of the current scenario 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, 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 published pediatric cases that have been treated with robot-assisted thoracic surgery (RATS) barely reaches 170 cases.

Conclusion: Our results are encouraging, although our experience is limited to a few cases. Robotic surgery for the treatment of pediatric 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.

In the future, it will be necessary to implement a greater miniaturization of technology, to treat children with less weight, the current limitation. More robotic systems will appear on the market in the coming years, with systems offering 5mm diameter or smaller diameter wrist instruments.

Robotic surgery with minirobots, to perform surgical tasks by remote control, seems like science fiction, but the future of the real minimally invasive surgery (MIS) is yet to come.