Surgical Endoscopy

, Volume 22, Issue 1, pp 177–182 | Cite as

Pediatric robotic surgery: A single-institutional review of the first 100 consecutive cases




Robotic surgery is a new technology which may expand the variety of operations a surgeon can perform with minimally invasive techniques. We present a retrospective review of our first 100 consecutive robotic cases in children.


A three-arm robot was used with one camera arm and two instrument arms. Additional accessory ports were utilized as necessary. Two different attending surgeons performed the procedures.


Twenty-four different types of procedures were completed using the robot. The majority of the procedures (89%) were abdominal procedures with 11% thoracic. No urology or cardiac procedures were performed. Age ranged from 1 day to 23 years with an average age of 8.4 years. Weight ranged from 2.2 to 103 kg with a median weight of 27.9 kg. Twenty-two patients were less than 10.0 kg. Examples of cases included gastrointestinal (GI) surgery, hepatobiliary, surgical oncology, and congenital anomalies. The overall majority of cases had never been performed minimally invasively by the authors. The overall intraoperative conversion rate to open surgery was 13%. One case (1%) was converted to thoracoscopic because of lack of domain for the articulating instruments. No conversions or complications occurred as a result of injuries from the robotic instruments. Interestingly, four abdominal cases were converted to open surgery due to equipment failures or injuries from standard laparoscopic instruments used through non-robotic accessory ports.


Robotic surgery is safe and effective in children. An enormous variety of cases can be safely performed including complex cases in neonates and small children. Simple operations such as cholecystectomies have minimal advantages by using robotic technology but can serve as excellent teaching tools for residents and newcomers to this form of minimally invasive surgery (MIS). The technology is ideal for complex hepatobiliary cases and thoracic surgery, particularly solid chest masses.


Pediatrics Robotic Surgery Laparoscopy Thoracoscopy 


  1. 1.
    Atug F, Castle EP, Woods M, Srivastav SK, Thomas R, Davis R (2006) Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: is one better than the other? Urology 68:1077–1081PubMedCrossRefGoogle Scholar
  2. 2.
    Mikhail AA, Orvieto MA, Billatos ES, Zorn KC, Gong EM, Brendler CB, Zagaja GP, Shalhav AL (2006) Robotic-assisted laparoscopic prostatectomy: first 100 patients with one year of follow-up. Urology 68:1275–1279PubMedCrossRefGoogle Scholar
  3. 3.
    Khaira HS, Bruyere F, O’Malley PJ, Peters JS, Costello AJ (2006) Does obesity influence the operative course or complications of robot-assisted laparoscopic prostatectomy. Brit J Urol Int 98:1275–1278Google Scholar
  4. 4.
    Tseng TY, Kuebler HR, Cancel QV, Sun L, Springhart WP, Murphy BC, Albala DM, Dahm P (2006) Prospective health-related quality-of-life assessment in an initial cohort of patients undergoing robotic radical prostatectomy. Urology 68:1061–1066PubMedCrossRefGoogle Scholar
  5. 5.
    Ryska M, Fronek J, Rudis J, Jurenka B, Langer D, Pudil J (2006) Manual and robotic laparoscopic liver resection. Two case-reviews. Rozhl Chir 85:511–516Google Scholar
  6. 6.
    Field JB, Benoit MF, Dinh TA, Diaz-Arrastia C (2007) Computer-enhanced robotic surgery in gynecologic oncology. Surg Endosc 21:244–246 PubMedCrossRefGoogle Scholar
  7. 7.
    Yu SC, Clapp BL, Lee MJ, Albrecht WC, Scarborough TK, Wilson EB (2006) Robotic assistance provides excellent outcomes during the learning curve for laparoscopic Roux-en-Y gastric bypass: results from 100 robotic-assisted gastric bypasses. Am J Surg 192:746–749PubMedCrossRefGoogle Scholar
  8. 8.
    Stadler P, Matous P, Vitasek P, Spacek M (2006) Robot-assisted aortoiliac reconstruction: A review of 30 cases. J Vasc Surg 44:915–919PubMedCrossRefGoogle Scholar
  9. 9.
    Atug F, Woods M, Burgess SV, Castle EP, Thomas R (2005) Robotic assisted laparoscopic pyeloplasty in children. J Urol 174:1440–1442PubMedCrossRefGoogle Scholar
  10. 10.
    Passerotti C, Peters CA (2006) Robotic-assisted laparoscopy applied to reconstructive surgeries in children. World J Urol 24:193–197PubMedCrossRefGoogle Scholar
  11. 11.
    Kutikov A, Nguyen M, Guzzo T, Canter D, Casale P (2006) Robot assisted pyeloplasty in the infant-lessons learned. J Urol 176:2237–2239PubMedCrossRefGoogle Scholar
  12. 12.
    Peters CA, Woo R (2005) Intravesical robotically assisted bilateral ureteral reimplantation. J Endourol 19:618–621PubMedCrossRefGoogle Scholar
  13. 13.
    Knight CG, Gidell KM, Lanning D, Lorincz A, Langenburg SE, Klein MD (2005). Laparoscopic Morgagni hernia repair in children using robotic instruments. J Laparoendosc Adv Surg Tech A 15:482–486PubMedCrossRefGoogle Scholar
  14. 14.
    Woo R, Le D, Albanese CT, Kim SS (2006) Robot-assisted laparoscopic resection of a type I choledochal cyst in a child. J Laparoendosc Adv Surg Tech A 16:179–183PubMedCrossRefGoogle Scholar
  15. 15.
    Chandra V, Dutta S, Albanese CT (2006) Surgical robotics and image guided therapy in pediatric surgery: emerging and converging minimal access technologies. Semin Pediatr Surg 15:267–275PubMedCrossRefGoogle Scholar
  16. 16.
    Samadi D, Levinson A, Hakimi A, Shabsigh R, Benson MC (2006) From proficiency to expert, when does the learning curve for robotic-assisted prostatectomies plateau? The Columbia University experience. World J Urol 25:105CrossRefGoogle Scholar
  17. 17.
    Meehan JJ, Georgeson KE (1997) The learning curve associated with laparoscopic antireflux surgery in infants and children. J Pediatr Surg 32:426–429PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Division of Pediatric SurgeryChildren’s Hospital of Iowa, University of Iowa Hospitals and ClinicsIowa CityUSA

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