Robotic surgery in children: when to choose this minimally-invasive technique
Written in association with:Robotic assistance for surgeries is a well-established technique for surgical procedures in which robotic technology, equipped with state-of-the-art cameras and instruments, are used to conduct a significant part of a surgery. They are not wholly independent, as a trained surgeon will actually perform the surgery via a specialised console, connected to the robotic “arms”. Robots are becoming an increasingly common figure in operating theatres, especially for adult surgeries. Their use in paediatric surgery is well-established in the US, but their use in the UK and rest of Europe is still becoming established, mainly due to the high costs involved in purchasing and maintaining the robotic equipment. Miss Marie-Klare Farrugia, an experienced paediatric urologist and surgeon, goes through the pros and cons, and the possibilities, of robotic surgery for children in this article.
The benefits of robotic surgery in children
Robots for surgery have several benefits that make them an attractive tool for both patients and doctors.
They are highly precise and mathematically accurate, with controlled, efficient movements that aren’t vulnerable to tremors and shakes like a human hand can be, even if that hand belongs to an expert surgeon. They are equipped with specified surgical instruments on “arms” which have a full range of motion, enabling them to manoeuvre in complicated spaces with dexterity that is not possible for a human to execute. On a child’s body, this is particularly vital as critical organs, tissues, and blood vessels are in a more constricted space.
They also have cameras – stereoscopic, high definition, in real-time, and with vivid colour – that are far superior to the quality of the image that a surgeon can get with a laparoscope, which tends to provide just a magnification of view. Robotic surgery is also more ergonomic for the surgeon, which can mean a quicker operating time than the laparoscopic equivalent, but this can vary depending on the complexity of the procedure, if any complications occur, and how familiar the surgeon is with the equipment.
Robotic surgery is designed to be minimally invasive, necessitating only a few small incisions, as opposed to open surgery which is often required when working with children’s smaller frames. Thus, the recovery is less painful, hence the the child may not require morphine or strong analgesics, which usually means less time convalescing in the hospital post-operation. In short, the healing process is quicker and more comfortable, which is important for children to protect their weaker immune systems and minimises scarring and pain, which can traumatise the child.
The drawbacks of robotic surgery in children
Robotic surgery may not be suitable for every child or case. It is mainly suited to intra-abdominal surgery that involves suturing or reconstruction. Though the arms allow access to intricate areas, the machines themselves require a bit of space in order to operate properly – the da Vinci systems, a staple of robotic-assisted surgeries that are currently available on the market, recommend 8cm in between each port (incision points), which may not be possible on children’s bodies, and especially on infants and neonates. Also, open surgery in babies requires smaller incisions than in older children, so the pain and recovery time is equivalent to minimally-invasive techniques. Hence, some robotic surgeons would choose to perform an open procedure in patients below the age of 2 years.
There is a learning curve for surgeons as they learn how to operate the robot systems, which may affect their confidence when performing procedures. The systems are also very expensive to purchase and teach, requiring storage, programmes, maintenance and upgrades that can prove to be a financial strain, in particular for NHS hospitals.
The future of robotic surgery in children
Currently, robotic assistance is steadily being incorporated into urologic procedures for both adults and children, and many young urologists are learning how to operate robots as part of their training. Robotic-assisted surgery is frequently performed for paediatric procedures such as pyeloplasty, nephrectomy, hemi-nephrectomy, ureteric reimplantation, and bladder reconstruction.
If you are considering robotic surgical treatment for your child, or if you would like further information, you can book a consultation with Miss Farrugia on her Top Doctors profile.
