Sinha C K, Haddad M
Department of Paediatric Surgery, Chelsea and Westminster Hospital, London, SW10 9NH UK.
J Robot Surg. 2008;1(4):243-6. doi: 10.1007/s11701-007-0054-6. Epub 2008 Jan 4.
The horizon of robotic paediatric surgery has grown in leaps and bounds with advances in technology. The aim of this study was to analyse the extent of robotic involvement in paediatric surgical practice. A systematic database search was performed. Data about children who had undergone robot-assisted procedures were reviewed retrospectively from all published reports up to October 2007. Success rates were defined in term of completion of the procedures, their complications, and the time taken. These results were further studied in comparison with the procedures performed by open and laparoscopic methods. A total of 31 studies were identified describing 566 patients. Of these, four studies were case control, comparing with either laparoscopic or open procedures, one study was a prospective trial, and the rest of the studies were either case reports or series. The most common robotic system used was the da Vinci (23 studies) followed by the Zeus (four studies). The mean age of the children was 8.3 years. The commonest operation was pyeloplasty (141 cases), followed by fundoplication (122 cases) and patent ductus arteriosus ligation (50 cases). The mean operation time for robot-assisted pyeloplasty was 221 min (open pyeloplasty 214 min). The mean operation times for fundoplication were robotic, 170 min, laparoscopic, 158 min, and open, 121 min. The mean operation times for patent ductus arteriosus ligation were 166 min (robotic) and 83 min (open). Overall conversion rate for all paediatric robotic procedures was 4.7% and complications ranged from 0 to 15%. For robotic fundoplications the conversion and complication rates were 0.8 and 3.3%, respectively. For robotic pyeloplasties the conversion and complication rates were 2.1 and 3.5%, respectively. Many other major operations were performed successfully. All studies recommended robotic procedure as safe and feasible. Currently, the most common robotic operations in practice are pyeloplasties and fundoplications. Most of the authors concluded that, despite taking more time, robotic surgery enables more refined hand-eye coordination, superior suturing skills, better dexterity, and precise dissection with minimal conversion and complication rates. The widespread acceptance of this technology largely depends on solving the issues: learning curve; suitable machine size for neonates and infants; ensuring efficacy and safety in all operations; and, most importantly, making this procedure cost effective, so as to cater for the needs of most, if not all, children.
随着技术的进步，小儿机器人手术的前景有了飞跃式的发展。本研究的目的是分析机器人技术在小儿外科手术实践中的应用程度。我们进行了系统的数据库检索。对截至2007年10月所有已发表报告中接受机器人辅助手术的儿童数据进行了回顾性分析。成功率根据手术的完成情况、并发症及所需时间来定义。将这些结果与开放手术和腹腔镜手术的结果进行了进一步比较。共确定了31项研究，描述了566例患者。其中，4项研究为病例对照研究，与腹腔镜手术或开放手术进行比较，1项研究为前瞻性试验，其余研究为病例报告或病例系列。使用最普遍的机器人系统是达芬奇系统（23项研究），其次是宙斯系统（4项研究）。儿童的平均年龄为8.3岁。最常见的手术是肾盂成形术（141例），其次是胃底折叠术（122例）和动脉导管未闭结扎术（50例）。机器人辅助肾盂成形术的平均手术时间为221分钟（开放肾盂成形术为214分钟）。胃底折叠术的平均手术时间为：机器人手术170分钟，腹腔镜手术158分钟，开放手术121分钟。动脉导管未闭结扎术的平均手术时间为：机器人手术166分钟，开放手术83分钟。所有小儿机器人手术的总体转换率为4.7%，并发症发生率在0%至15%之间。机器人辅助胃底折叠术的转换率和并发症发生率分别为0.8%和3.3%。机器人辅助肾盂成形术的转换率和并发症发生率分别为2.1%和3.5%。还成功进行了许多其他大型手术。所有研究均推荐机器人手术安全可行。目前，实践中最常见的机器人手术是肾盂成形术和胃底折叠术。大多数作者得出结论，尽管机器人手术耗时更长，但它能实现更精细的手眼协调、更出色的缝合技术、更好的灵活性以及精确的解剖，且转换率和并发症发生率最低。这项技术的广泛应用很大程度上取决于解决以下问题：学习曲线；适合新生儿和婴儿的机器尺寸；确保所有手术的有效性和安全性；以及最重要的是，使该手术具有成本效益，以满足大多数（如果不是全部）儿童的需求。
