Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France.
Department of Paediatric Anaesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, France.
Anaesth Crit Care Pain Med. 2021 Jun;40(3):100837. doi: 10.1016/j.accpm.2021.100837. Epub 2021 Mar 20.
Paediatric robotic surgery is gaining popularity across multiple disciplines and offers technical advantages in complex procedures requiring delicate dissection. To date, limited publications describe its perioperative management in children.
MATERIAL & METHODS: We retrospectively analysed the prospectively collected anaesthetic data of the first 200 robotic-assisted surgery procedures in our paediatric university hospital as part of a multidisciplinary program from October of 2016 to February of 2019. Anaesthetic technique and monitoring were based on guidelines initially derived from adult data. We examined adverse events and particular outcomes including blood loss and analgesic requirements.
Fifty-one different surgical procedures were performed in patients aged 4 months to 18 years (weight 5-144 kg). Operative times averaged 4 h and conversion rate was 3%. Neither robotic arm nor positional injury occurred. Limited access to the patient did not lead to any complication. Hypothermia was frequent and mostly self-limiting. Negative physiological effects due to positioning, body cavity insufflation or surgery manifesting as significant respiratory and haemodynamic changes occurred in 14% and 11% of patients, respectively. Overt haemorrhage complicated one case. Eighty per cent of 170 patients did not require level 3 analgesics postoperatively, while thoracic and certain tumour cases had greater analgesic requirements.
These preliminary results show that paediatric robotic surgery is well tolerated with a low bleeding risk and that major intraoperative events are uncommon. A consistent anaesthetic approach is effective across a broad range of procedures. Analgesic requirements are low excluding thoracic and some complex abdominal cases. Future studies should focus on the rehabilitative aspects of robotic surgery technique.
儿科机器人手术在多个学科中越来越受欢迎，为需要精细解剖的复杂手术提供了技术优势。迄今为止，有限的出版物描述了其在儿童中的围手术期管理。
我们回顾性分析了 2016 年 10 月至 2019 年 2 月期间我们儿童医院多学科机器人辅助手术项目的前 200 例机器人辅助手术的前瞻性收集的麻醉数据。麻醉技术和监测最初基于成人数据得出的指南。我们检查了不良事件和特定结果，包括出血量和镇痛需求。
51 种不同的手术在 4 个月至 18 岁的患者（体重 5-144kg）中进行。手术时间平均为 4 小时，转化率为 3%。没有发生机器人手臂或位置性损伤。有限的患者通道不会导致任何并发症。体温过低很常见，且大多是自限性的。由于定位、体腔充气或手术导致的生理负面影响分别在 14%和 11%的患者中出现，表现为显著的呼吸和血流动力学变化。1 例出现明显出血。170 例患者中有 80%术后不需要 3 级镇痛，而胸部和某些肿瘤病例的镇痛需求更大。
这些初步结果表明，儿科机器人手术具有较低的出血风险，耐受性良好，术中重大事件不常见。一致的麻醉方法对广泛的手术都有效。排除胸部和某些复杂腹部病例，镇痛需求较低。未来的研究应侧重于机器人手术技术的康复方面。
