Ensuring safety and feasibility for resection of pediatric benign ovarian tumors by single-port robot-assisted laparoscopic surgery using the da Vinci Xi system

Comparison of robotic vs. laparoscopic treatment in pediatric ovarian benign tumors

OBJECTIVE

To compare the differences in surgical outcomes of robot-assisted treatment and laparoscopy for benign ovarian tumors among pediatric patients.

METHODS

A total of 39 patients underwent robot-assisted surgery, and their outcomes were compared with 55 patients treated with laparoscopy during the same period by the same surgeons.

RESULTS

There were no significant differences between the two groups in terms of age (7.5 ± 4.5 vs. 8.8 ± 3.8 years, p = 0.2496), weight (29.3 ± 17.7 vs. 31.7 ± 14.6 kg, p = 0.4383), or tumor size (5.0 ± 3.3 vs. 5.1 ± 3.8 cm, p = 0.8541). However, the operative time was significantly longer in the robotic surgery group (102.7 ± 33.5 vs. 89.3 ± 50.9 min, p = 0.0112). There was no significant difference in intraoperative blood loss. Fewer patients in the robotic surgery group opted for day surgery compared to the laparoscopy group (15.4% vs. 54.5%, p < 0.001). There was no significant difference in the length of hospital stay between the two groups of patients who chose inpatient surgery (5.6 ± 3.4 vs. 4.4 ± 2.9 d, p = 0.1213). There was no conversion to open surgery and no early postoperative complications in both groups.

CONCLUSION

Robot-assisted surgery and laparoscopy yield comparable outcomes for the treatment of benign ovarian tumors in children, although robotic surgery has a longer operative time.

Single-port plus one in pediatric robotic-assisted Lich-Gregoir ureteral reimplantation for vesicoureteral reflux, a comparative analysis with short-term outcomes

OBJECTIVE

To observe the safety and short-term outcomes of a new way of laparoscopic trocar placement in pediatric robotic-assisted Lich-Gregoir ureteral reimplantation for vesicoureteral reflux.

METHODS

The retrospective study included 32 patients under 14 years diagnosed with primary vesicoureteral reflux (VUR). All these patients underwent robotic-assisted Lich-Gregoir ureteral reimplantation in our department from December 2020 to August 2022. These patients were divided into the following groups according to the different ways of trocar placement: 13 patients in group single-port plus one (SR) and 19 patients in group multiple-port (MR). Patients' characteristics as well as their perioperative and follow-up data were collected and evaluated.

RESULTS

There was no significant difference in the data regarding patients' characteristics and preoperative data. These data included the grade of vesicoureteral reflux according to the voiding cystourethrogram (VCUG), and the differential degree of renal function (DRF) at the following time points: preoperative, postoperative, and comparison of preoperative and postoperative. There was no difference between the two groups. During surgery, the time of artificial pneumoperitoneum establishment, ureteral reimplantation time, and total operative time in the SR group were longer than those in the MR group. Yet only the time of artificial pneumoperitoneum establishment shows a statistical difference (P < 0.0001). Also, the peri-operative data, including the volume of blood loss, fasting time, hospitalization, and length of time that a ureteral catheter remained in place, and the number of postoperative complications demonstrate no difference. In addition, the SFU grade and VCUG grade at the following time point also show no difference between the two groups.

CONCLUSION

The study demonstrates that SR in robotic-assisted Lich-Gregoir ureteral reimplantation has reached the same surgical effects as MR. In addition, the single-port plus one trocar placement receives a higher cosmetic satisfaction score from parents and did not increase the surgical time and complexity.

Robotic-assisted surgery for gynecological indications in children and adolescents: European multicenter report

Robotic-assisted surgery (RAS) is increasingly adopted in the pediatric population. This retrospective multicenter study aimed to report application of RAS for gynecological indications in pediatric patients. The medical records of all girls with gynecological pathology, operated in 4 different institutions over a 3-year period, were retrospectively collected. Robot docking time, total operative time, length of stay (LOS), requirement time of pain medication, complication rate, conversion rate, and pathology were analyzed. Twenty-three girls, with median age of 12.3 years (range 0.6-17.8) and median weight of 47.2 kg (range 9-73), received the following RAS procedures: ovarian cystectomy for ovarian cyst/mass (n = 10), salpingo-oophorectomy for ovarian complex mass (n = 6), bilateral gonadectomy for Turner syndrome SRY + (n = 1), salpingectomy for fallopian tube lesion (n = 1), paratubal cyst excision (n = 1), Gartner cyst excision (n = 1), paravaginal ganglioneuroma resection (n = 1), fistula closure in urogenital sinus (n = 1), and vaginoplasty using ileal flap in cloaca malformation (n = 1). Median operative time was 144.9 min (range 64-360), and median docking time was 17.3 min (range 7-50). Conversion to open or laparoscopy was not necessary in any case. Median LOS was 2.1 days (range 1-7), and median analgesic requirement was 2.2 days (range 1-6). One patient (4.3%) needed redo-surgery for recurrent Gartner cyst (Clavien 3b). This preliminary experience showed that RAS is safe and feasible for surgical treatment of gynecological pathology in pediatric patients, although no conclusive data are available to confirm its superiority over traditional laparoscopy. Randomized, prospective, comparative studies are needed to identify the gold standard approach for such indication.