Robot Assisted Laparoscopic Surgery is Safe and Efficacious in Infants <10 kg in Weight
Edward M. Gong, MD, Rachel Shannon, BS, Ilina Rosoklija, MPH, Dennis Liu, MD, Bruce Lindgren, MD.
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
BACKGROUND: Robot assisted laparoscopic surgery has become increasingly utilized in the pediatric patients. There have been several series demonstrating safety and efficacy in infants, however, stratification by infant size has not been reported. We evaluated the results of robot assisted laparoscopy in the management of urologic diseases in children under 10 kg of weight.
METHODS: Between 2011 and 2018, 496 robotic urologic surgeries were performed at a single institution by 6 experienced robotic surgeons. We identified 60 patients who were both less than 1 year of age and ≤10 kg and evaluated demographic, operative, and post-operative data. Furthermore, we compared outcomes between children <8 kg and >8 kg. Data analysis was performed with (T-test and Fisher’s exact test). RESULTS: The median age of patients was 0.65 years (0.39 - 0.99). The median weight was 8.2 kg (6.3 - 10.0kg) with 26 patients ≤ 8 kg and 34 patients > 8 kg. Patients underwent a variety of surgeries including 43 pyeloplasties (64.2%), 15 IUU (22.4%), 1 nephrectomy (1.5%), and 1 heminephrectomy (1.5%) by 6 robot-experienced surgeons. Median operative time was 207 min (141 - 372 min) with a median console time of 127 min (68 - 276 min). Median EBL was 5 ml (1 - 20 ml) and no intra-operative complications were identified. Median admission was 24.7 hrs (13.5-234.8 hrs). Five patients (8.3%) had an extended admission course with 2 patients demonstrating respiratory distress, 1 febrile UTI, 1 sinus tachycardia in a patient with known cardiac issues, and 1 unexplained post-operative fever. Five patients (8.3%) required readmission with 4 febrile UTI. Three patients underwent re-operation with 1 re-operative pyeloplasty, 1 stent exchange for stent malfunction, and 1 port-site hernia. With a median follow-up of 12.5 mo. (0 - 73.6 mo), we identified 58 patients (96.7%) with post-surgical imaging that demonstrated radiographic improvement or resolution (98.3%). Comparing children <8 vs >8kg we did not see a difference in operative times, blood loss, complications, re-operative procedures, or radiographic improvement. CONCLUSIONS:
We demonstrate that RAL procedures in infants of <10 kg is safe and efficacious. Smaller children <8kg in weight did not affect Identification of specific measurements that can allow for precise determination of the low end of size for RAL surgery would be beneficial.
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