Robotic surgery in children: the good, the bad, and the possibilities

Robotic assistance for surgeries is a blossoming technique for surgical procedures in which robots, equipped with state-of-the-art cameras and tools, are used to conduct a significant part of a surgery. They are not wholly independent, as a trained surgeon will operate one whilst other surgeons support the procedure, and a specialist team stays close by for technical assistance. Robots are becoming an increasingly common figure in operating theatres, especially for adult surgeries, but their use in paediatric surgery is still limited and rare – for all the benefits of robotic surgery, there are also some caveats that are important to consider when operating on children. 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 allegedly faster than regular surgery, 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 child patient has to spend 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, so an overreliance on the technology can hinder a procedure, rather than assist. 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.

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 for the hospital and also may mean that patients and their families are unable to afford treatment.

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. There have been successful paediatric urological surgeries with robotic assistance such as nephrectomy, bladder reconstruction, and removal of large kidney stones. For all the possible disadvantages of robotic surgery, the technology is actively evolving and these restrictions will surely be addressed and ironed out. The robots will get smaller and more nimble. There may come a day when robotic surgery is the gold standard of surgical techniques in all schools of medicine, including paediatric surgery.

If you are considering robotic surgical treatment for your child, you can book a consultation with a specialist today on Top Doctors.