AND THEN THERE WAS ONE⋯INCISION. FIRST SINGLE-PORT PEDIATRIC ROBOTIC CASE SERIES
Niki Parikh, MD, MBA, MSBA, Patricio Gargollo, MD, Candace Granberg, MD.
Mayo Clinic, Rochester, MN, USA.
BACKGROUND: Pediatric surgery began with single-incision flank surgery and has evolved to standard multi-port laparoscopic and robotic approaches. To decrease visibility of incisions, hidden incision endoscopic surgery was developed. Recent technological advances with the single-port (SP) robot have allowed for the transition back to single-incision surgery. We sought to document the feasibility of the single-port robotic platform in the first clinical series of pediatric patients. Secondary aims were to report intraoperative details and perioperative outcomes. METHODS: Seven patients (22 mo-14 y) underwent surgery using the daVinci SP Surgical System. Six patients, 2 girls and 4 boys, were diagnosed with ureteropelvic junction obstruction and underwent SP robotic-assisted dismembered pyeloplasty while one male patient with neurogenic bladder underwent SP robotic-assisted Mitrofanoff procedure. A 2.5 cm incision was made within the Pfannenstiel line in a HIdES fashion for the pyeloplasties, while prior gastrostomy tube site was used for the Mitrofanoff. Through this incision a 25-mm multichannel port was placed. The 12 x 10mm articulating robotic camera and two 6mm articulating robotic instruments were utilized. RESULTS:All surgeries were completed successfully through the single port without any intraoperative complications, need for additional ports, or conversion. Median operative time was 120 minutes and estimated blood loss was less than 25 cc. All patients were dismissed in less than 24 hours, taking only alternating acetaminophen and ibuprofen for pain control. There was no issue with instrumentation in the older patients; however, shorter working distance in the 22-month-old pyeloplasty limited wristing of the instruments.
We report the first cases utilizing the SP robotic platform in children. Single-port robotic surgery is feasible in pediatric patients, but patient selection is key. To optimize use, a 10-cm working distance must be maintained, limiting use to older children. To help improve working space a Gel-Port can be utilized with the port retracted outside of the body to gain working space. In addition, needles can be placed into the abdomen after incision and prior to port placement to prevent loss of insufflation. Future development of the platform is needed to widen application to smaller patients.
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