Presented by: Goktug Kalender MD
Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine

Introduction

Despite all the advantages of robot-assisted laparoscopic surgery (RALS), there may be difficulties in its application in children depending on physical characteristics especially in docking protocol, which may lead to longer operational time. We aimed to identify novel criterias; which affect the docking time in pediatric robotic urological surgery.

Materials

Pediatric patients (0-17yrs) with anterior superior iliac spinal distance > 13 and puboxiphoid distance >15 cm whom underwent RALS between the years 2018-2021 were included into the study. Procedures were performed under the command of a single experienced surgeon using transperitoneal approach.Docking time was identified as the timespan; enclosing the planning of the trocar entry sites, their placement and the attachement of the respective robotic arms. Console time presented the timespan of the surgical protocol before undocking. The patient groups were determined according to the docking time (Group 1≤ 25 minutes, Group 2> 25 minutes). 

Results

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RALS was performed on 20 patients(M:F=2.3) with a median age of 72,6 months(10-204). The urologic surgeries performed on patients were specified as pyeloplasty(n=11), ureteroneocystostomy(n=4), heminephrectomy(n=3),nephrectomy(n=1) and diverticulectomy (n=1). Children with longer docking time(Group 2;n=10)  were found to have younger ages(mean 104 vs 40 months;p=0.006), less body weight(mean 35 vs 17 kg; p=0.003) and smaller stature(mean 135 vs 99 cm;p=0.001). Variations in trocar placement based on procedure protocols (transvers vs linear:11/9) had no statistically significant effect on docking time(p=0.780). The console time were similar in groups (p=0.67). 

Conclusion

RALS is a feasible surgical option for pediatric patients. Longer operation times; which had been atributed as a disadvantage of this technique, can be avoided by proper patient selection prior to surgery. Patients age, height and weight should be considered when evaluating a patients eligibility for RALS. 

Funding

None.

Lead Authors

Bülent Önal, MD
Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine

Elif Altınay Kırlı, MD
Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine

Uğur Aferin, MD
Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine

Muhammet Demirbilek, MD
Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine