Surgical Endoscopy

, Volume 24, Issue 11, pp 2803–2808

Initiation of a pediatric robotic surgery program: institutional challenges and realistic outcomes

  • Mathew D. Sorensen
  • Michael H. Johnson
  • Catherine Delostrinos
  • Jeff B. Bice
  • Richard W. Grady
  • Thomas S. Lendvay
Article

DOI: 10.1007/s00464-010-1052-8

Cite this article as:
Sorensen, M.D., Johnson, M.H., Delostrinos, C. et al. Surg Endosc (2010) 24: 2803. doi:10.1007/s00464-010-1052-8

Abstract

Background

Few institutions have reported their experience initiating a pediatric robot-assisted laparoscopic (RAL) program, and results vary regarding the outcomes for robotic surgery in children. We present the initiation of our pediatric robotic surgery program, provide suggestions for overcoming institutional challenges, and perform a comparative analysis to illustrate realistic outcomes during the learning curve.

Methods

Outcomes from consecutive children who underwent RAL surgery since the 2006 acquisition of the da Vinci® surgical system were retrospectively reviewed. To evaluate the safety and outcomes during the introduction of this new technology, we performed an outcome analysis of ureteral reimplantations comparing RAL cases to matched open controls.

Results

The first 50 RAL cases were performed over 20 months by two general and two urologic surgeons. Fourteen different procedures were performed successfully. The average patient age was 8.6 ± 5.7 years with 10 patients weighing less than 10 kg (20%). Three urologic cases were converted to traditional laparoscopy and two general surgery cases were converted to open. There were five mechanical failures. Initial outcomes comparing RAL and open ureteral reimplantations revealed similar length of stay, complications, and success with lower estimated blood loss in the RAL group. Overall OR time was 53% longer in the RAL reimplant group (361 ± 80 vs. 236 ± 58 min, p < 0.0001).

Conclusion

Robotic surgery appears to be safe in pediatric patients for many procedures. Proper instruction and training precedes technological proficiency. The institutional learning curve may be magnified when there are multiple participating surgeons. Operative times for initial RAL cases can be expected to be greater than their open correlates.

Keywords

Robotic surgery RAL Laparoscopy Case control analysis New technology Pediatrics 

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Mathew D. Sorensen
    • 1
    • 3
  • Michael H. Johnson
    • 1
  • Catherine Delostrinos
    • 1
  • Jeff B. Bice
    • 1
  • Richard W. Grady
    • 1
    • 2
  • Thomas S. Lendvay
    • 1
    • 2
  1. 1.Department of UrologyUniversity of Washington School of MedicineSeattleUSA
  2. 2.Division of Pediatric UrologySeattle Children’s HospitalSeattleUSA
  3. 3.University of Washington School of MedicineSeattleUSA