Pediatric Surgery International

, Volume 31, Issue 12, pp 1119–1125 | Cite as

Robotic surgery in children: adopt now, await, or dismiss?

  • Thomas P. Cundy
  • Hani J. Marcus
  • Archie Hughes-Hallett
  • Sanjeev Khurana
  • Ara Darzi
Review Article

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.

Keywords

Pediatric Robotic Technology 

References

  1. 1.
    Cundy TP, Shetty K, Clark J et al (2013) The first decade of robotic surgery in children. J Pediatr Surg 48:858–865CrossRefPubMedGoogle Scholar
  2. 2.
    Monn MF, Bahler CD, Schneider EB et al (2013) Trends in robot-assisted laparoscopic pyeloplasty in pediatric patients. Urology 81:1336–1341CrossRefPubMedGoogle Scholar
  3. 3.
    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 28:592–598CrossRefPubMedGoogle Scholar
  4. 4.
    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 191:1090–1095PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Rogers EM (2003) Diffusion of innovations. 5th edn, New YorkGoogle Scholar
  6. 6.
    Cundy TP, Harling L, Marcus HJ et al (2014) Meta analysis of robot-assisted versus conventional laparoscopic fundoplication in children. J Pediatr Surg 49:646–652CrossRefPubMedGoogle Scholar
  7. 7.
    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 114:582–594CrossRefPubMedGoogle Scholar
  8. 8.
    Meehan JJ, Sandler A (2008) Pediatric robotic surgery: a single-institutional review of the first 100 consecutive cases. Surg Endosc 22:177–1782CrossRefPubMedGoogle Scholar
  9. 9.
    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 48:1750–1756CrossRefPubMedGoogle Scholar
  10. 10.
    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 9:142–147CrossRefPubMedGoogle Scholar
  11. 11.
    Brody F, Richards NG (2014) Review of robotic versus conventional laparoscopic surgery. Surg Endosc 28:1413–1424CrossRefPubMedGoogle Scholar
  12. 12.
    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
  13. 13.
    Krummel TM, Gertner M, Makower J et al (2006) Inventing our future: training the next generation of surgeon innovators. Semin Pediatr Surg 15:309–318CrossRefPubMedGoogle Scholar
  14. 14.
    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 28:1388–1398CrossRefPubMedGoogle Scholar
  15. 15.
    Yoo J (2014) The robot has no role in elective colon surgery. JAMA Surg 149:184CrossRefPubMedGoogle Scholar
  16. 16.
    Weissman JS, Zinner M (2013) Comparative effectiveness research on robotic surgery. JAMA 309:721–722CrossRefPubMedGoogle Scholar
  17. 17.
    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 Google Scholar
  18. 18.
    Winter DC (2009) The cost of laparoscopic surgery is the price of progress. Br J Surg 96:327–328CrossRefPubMedGoogle Scholar
  19. 19.
    Buchs NC, Volonte F, Pugin F et al (2013) Three-dimensional laparoscopy: a step toward advanced surgical navigation. Surg Endosc 27:692–693CrossRefPubMedGoogle Scholar
  20. 20.
    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 27:696–699CrossRefPubMedGoogle Scholar
  21. 21.
    Storz P, Buess GF, Kunert W et al (2012) 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc 6:1454–1460CrossRefGoogle Scholar
  22. 22.
    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 51:1015–1022CrossRefPubMedGoogle Scholar
  23. 23.
    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 48:1445–1449CrossRefPubMedGoogle Scholar
  24. 24.
    Peters CA (2009) Pediatric robotic-assisted surgery: too early an assessment? Pediatrics 124:1680–1681CrossRefPubMedGoogle Scholar
  25. 25.
    Meininger D, Byhahn C, Mierdl S et al (2005) Hemodynamic and respiratory effects of robot-assisted laparoscopic fundoplication in children. World J Surg 29:615–619CrossRefPubMedGoogle Scholar
  26. 26.
    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 49:1522–1526CrossRefPubMedGoogle Scholar
  27. 27.
    Ramsay CR, Grant AM, Wallace SA et al (2001) Statistical assessment of the learning curves of health technologies. Health Technol Assess 5:1–79CrossRefPubMedGoogle Scholar
  28. 28.
    Vitiello V, Lee SL, Cundy TP et al (2013) Emerging robotic platforms for minimally invasive surgery. IEEE Rev Biomed Eng 6:111–126CrossRefPubMedGoogle Scholar
  29. 29.
    Kaouk JH, Haber GP, Autorino R et al (2014) A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 66:1033–1043CrossRefPubMedGoogle Scholar
  30. 30.
    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 4105–4110Google Scholar
  31. 31.
    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 61:1305–1317CrossRefPubMedGoogle Scholar
  32. 32.
    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 2430–2435Google Scholar
  33. 33.
    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 786–792Google Scholar
  34. 34.
    Bergeles C, Yang GZ (2014) From passive tool holders to microsurgeons: safer, smaller, smarter surgical robots. IEEE Trans Biomed Eng 61:1565–1576CrossRefPubMedGoogle Scholar
  35. 35.
    Wilson CB (2006) Adoption of new surgical technology. BMJ 332:112–114PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Thomas P. Cundy
    • 1
    • 2
    • 3
  • Hani J. Marcus
    • 1
  • Archie Hughes-Hallett
    • 1
  • Sanjeev Khurana
    • 2
    • 3
  • Ara Darzi
    • 1
  1. 1.The Hamlyn Centre, Institute of Global Health InnovationImperial College LondonLondonUK
  2. 2.Department of Paediatric SurgeryWomen’s and Children’s HospitalAdelaideSouth Australia
  3. 3.Discipline of SurgeryUniversity of AdelaideAdelaideSouth Australia

Personalised recommendations