Abstract
The role of robot-assisted surgery in children remains controversial. This article aims to distil this debate into an evidence informed decision-making taxonomy; to adopt this technology (1) now, (2) later, or (3) not at all. Robot-assistance is safe, feasible and effective in selected cases as an adjunctive tool to enhance capabilities of minimally invasive surgery, as it is known today. At present, expectations of rigid multi-arm robotic systems to deliver higher quality care are over-estimated and poorly substantiated by evidence. Such systems are associated with high costs. Further comparative effectiveness evidence is needed to define the case-mix for which robot-assistance might be indicated. It seems unlikely that we should expect compelling patient benefits when it is only the mode of minimally invasive surgery that differs. Only large higher-volume institutions that share the robot amongst multiple specialty groups are likely to be able to sustain higher associated costs with today’s technology. Nevertheless, there is great potential for next-generation surgical robotics to enable better ways to treat childhood surgical diseases through less invasive techniques that are not possible today. This will demand customized technology for selected patient populations or procedures. Several prototype robots exclusively designed for pediatric use are already under development. Financial affordability must be a high priority to ensure clinical accessibility.
Similar content being viewed by others
References
Cundy TP, Shetty K, Clark J et al (2013) The first decade of robotic surgery in children. J Pediatr Surg 48:858–865
Monn MF, Bahler CD, Schneider EB et al (2013) Trends in robot-assisted laparoscopic pyeloplasty in pediatric patients. Urology 81:1336–1341
Sukumar S, Roghmann F, Sood A et al (2014) Correction of ureteropelvic junction obstruction in children: national trends and comparative effectiveness in operative outcomes. J Endourol 28:592–598
Varda BK, Johnson EK, Clark C et al (2014) National trends of perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. J Urol 191:1090–1095
Rogers EM (2003) Diffusion of innovations. 5th edn, New York
Cundy TP, Harling L, Marcus HJ et al (2014) Meta analysis of robot-assisted versus conventional laparoscopic fundoplication in children. J Pediatr Surg 49:646–652
Cundy TP, Harling L, Hughes-Hallett A et al (2014) Meta analysis of robot-assisted versus conventional laparoscopic and open pyeloplasty in children. BJU Int 114:582–594
Meehan JJ, Sandler A (2008) Pediatric robotic surgery: a single-institutional review of the first 100 consecutive cases. Surg Endosc 22:177–1782
Esposito C, El Ghoneimi A, Yamataka A et al (2013) Work-related upper limb musculoskeletal disorders in pediatric laparoscopic surgery. A multicenter survey. J Pediatr Surg 48:1750–1756
Hubert N, Gilles M, Desbrosses K et al (2013) Ergonomic assessment of the surgeon’s physical workload during standard and robotic assisted laparoscopic procedures. Int J Med Robot 9:142–147
Brody F, Richards NG (2014) Review of robotic versus conventional laparoscopic surgery. Surg Endosc 28:1413–1424
Tsuda S, Oleynikov D, Gould J et al (2015) SAGES TAVAC safety and effectiveness analysis: da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA). Surg Endosc. doi:10.1007/s00464-015-4428-y
Krummel TM, Gertner M, Makower J et al (2006) Inventing our future: training the next generation of surgeon innovators. Semin Pediatr Surg 15:309–318
Heemskerk J, Bouvy ND, Baeten CG (2014) The end of robot-assisted laparoscopy? A critical appraisal of scientific evidence on the use of robot-assisted laparoscopic surgery. Surg Endosc 28:1388–1398
Yoo J (2014) The robot has no role in elective colon surgery. JAMA Surg 149:184
Weissman JS, Zinner M (2013) Comparative effectiveness research on robotic surgery. JAMA 309:721–722
Basto M, Sathianathan N, Marvelde LT et al (2015) A patterns of care and health economic analysis of robotic radical prostatectomy in the Australian public health system. BJU Int. doi:10.1111/bju.13317
Winter DC (2009) The cost of laparoscopic surgery is the price of progress. Br J Surg 96:327–328
Buchs NC, Volonte F, Pugin F et al (2013) Three-dimensional laparoscopy: a step toward advanced surgical navigation. Surg Endosc 27:692–693
Kunert W, Storz P, Kirschniak A (2013) For 3D laparoscopy: a step toward advanced surgical navigation: how to get maximum benefit from 3D vision. Surg Endosc 27:696–699
Storz P, Buess GF, Kunert W et al (2012) 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc 6:1454–1460
Frede T, Hammady A, Klein J et al (2007) The radius surgical system—a new device for complex minimally invasive procedures in urology? Eur Urol 51:1015–1022
Lukish J, Rasmussen S, Garrett D et al (2013) Utilization of a novel unidirectional knotless suture during minimal access procedures in pediatric surgery. J Pediatr Surg 48:1445–1449
Peters CA (2009) Pediatric robotic-assisted surgery: too early an assessment? Pediatrics 124:1680–1681
Meininger D, Byhahn C, Mierdl S et al (2005) Hemodynamic and respiratory effects of robot-assisted laparoscopic fundoplication in children. World J Surg 29:615–619
Cundy TP, Marcus HJ, Hughes-Hallett A et al (2014) International attitudes of early adopters to current and future robotic technologies in pediatric surgery. J Pediatr Surg 49:1522–1526
Ramsay CR, Grant AM, Wallace SA et al (2001) Statistical assessment of the learning curves of health technologies. Health Technol Assess 5:1–79
Vitiello V, Lee SL, Cundy TP et al (2013) Emerging robotic platforms for minimally invasive surgery. IEEE Rev Biomed Eng 6:111–126
Kaouk JH, Haber GP, Autorino R et al (2014) A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 66:1033–1043
Looi T, Yeung B, Umasthan M et al (2013) KidsArm—an image-guided pediatric anastomosis robot. Proceedings of the IEEE/RSJ International Conference on Intelligent Robots and Systems 4105–4110
Leonard S, Wu KL, Kim Y et al (2014) Smart tissue anastomosis robot (STAR): a vision-guided robotics system for laparoscopic suturing. IEEE Trans Biomed Eng 61:1305–1317
Liu Q, Kobayashi Y, Zhang B et al (2014) Development of a smart surgical robot with bended forceps for infant congenital esophageal atresia surgery. Proceedings of the IEEE International Conference on Robotics and Automation 2430–2435
Damian D, Arabagi S, Fabozzo A et al (2014) Robotic implant to apply tissue traction forces in the treatment of esophageal atresia. Proceedings of the IEEE International Conference on Robotics and Automation 786–792
Bergeles C, Yang GZ (2014) From passive tool holders to microsurgeons: safer, smaller, smarter surgical robots. IEEE Trans Biomed Eng 61:1565–1576
Wilson CB (2006) Adoption of new surgical technology. BMJ 332:112–114
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding source
No specific funding support.
Financial disclosure statement
The authors declare no financial relationships.
Conflicts of interest
The authors declare no conflicts of interest.
Rights and permissions
About this article
Cite this article
Cundy, T.P., Marcus, H.J., Hughes-Hallett, A. et al. Robotic surgery in children: adopt now, await, or dismiss?. Pediatr Surg Int 31, 1119–1125 (2015). https://doi.org/10.1007/s00383-015-3800-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-015-3800-2