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Robotic assisted thoracoscopic surgery in children: a narrated review

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Abstract

Aim

This study reviewed the literature on the robotic assisted thoracoscopic surgery in children.

Methods

A systematic search of Pubmed and Scopus databases was performed for “robotic” AND “thoracoscopic” AND “pediatric”. Excluded articles included the articles for which fulltext in English was not available, duplicate articles, and review articles. Demographic characteristics, type of the surgery performed, age and weight of the child, duration of the surgery, ports employed, complications and length of hospital stay were analysed.

Results

The database search retrieved 115 articles, after excluding the articles which were not meeting inclusion criteria, 24 articles (184 patients) were selected for the review. Indication for majority of the robotic assisted thoracoscopic surgery included lung resection like lobectomy or segmentectomy (25.5%), followed by thymectomy (19%). Neonatal robotic assisted thoracoscopic surgery was performed for trachea- esophageal fistula and congenital diaphragmatic hernia, with higher conversion rate to thoracoscopic or open surgery (61.5%). Though mean age was not mentioned for majority of the patients, it was 82.5 months for 131 patients, which included outliers like neonates. Mean age of the neonates at the time of the surgery was 7.2 days. Robotic assisted thoracoscopic surgery has been performed in children weighing as less as 2.8 kg, and the mean weight for all the patients included in the study was 26.4 kg. Reported complication rate was 7% and all of the described complications were Clavein- Dindo class II, which were managed conservatively.

Discussion

Until recently, robotic assisted surgery in pediatric patients were limited to abdominal surgeries. However, increasing number of thoracoscopic surgeries are being performed in children with robotic assistance. RATS have been performed in children weighing as low as 2.8 kg. Reported conversion rate is higher for neonates undergoing robotic surgery due to difficulty in manoeuvring the instruments. With similar complication rate and conversion rate as thoracoscopic surgery, RATS can be employed in children. Due to steep learning curve for robotic surgery, the operative time is expected to reduce over the time. We conclude that the RATS is safe and feasible in children, with better outcome. Non-availability of the appropriate sized instruments especially for neonates is the major disadvantage faced for the pediatric patients which needs attention.

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Data availability

The data that support the findings of this study are openly available in Scopus and PUBMED database.

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Authors and Affiliations

  1. Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, India

    Shrilakshmi Aithal, Arvind Sinha & Manish Pathak

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  1. Shrilakshmi Aithal
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  2. Arvind Sinha
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Correspondence to Arvind Sinha.

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Aithal, S., Sinha, A. & Pathak, M. Robotic assisted thoracoscopic surgery in children: a narrated review. J Ped Endosc Surg (2024). https://doi.org/10.1007/s42804-023-00210-y

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