Robotic Surgery in Pediatric Oncology |
| Robotic-assisted
surgery has emerged as a revolutionary approach in pediatric oncology,
offering increased precision, reduced invasiveness, and shorter
recovery times compared to traditional surgical methods. Despite its
widespread adoption in adult oncology, its application in pediatric
patients remains limited due to concerns regarding safety, feasibility,
and cost. However, recent studies and clinical experiences indicate
that robotic-assisted techniques are not only viable but also
beneficial in select pediatric oncological procedures. One of the primary advantages of robotic-assisted surgery is the ability to perform highly precise movements within small anatomical spaces. The robotic platform offers three-dimensional visualization, tremor filtration, and motion scaling, all of which enhance the surgeon's ability to perform delicate dissections and resections. These features are particularly advantageous in pediatric surgery, where tissue preservation and minimal disruption to surrounding structures are paramount. The da Vinci Surgical System has been at the forefront of robotic pediatric oncology, demonstrating its potential in abdominal, thoracic, and pelvic tumor resections. A nationwide study reviewing the first 100 robotic-assisted tumor resections in pediatric patients highlighted the feasibility and safety of this technique. Over a four-year period, 89 children underwent 93 robotic-assisted procedures, with a variety of tumor types addressed, including neuroblastomas, Wilms' tumors, germ cell tumors, and neuroendocrine tumors. The median age at surgery was 8.2 years, and the median hospital stay was three days. Importantly, no intraoperative tumor ruptures were reported, and only seven cases (8%) required conversion to an open approach due to technical difficulties. These findings suggest that robotic surgery can be a safe and effective option for pediatric tumors when performed in specialized centers with experienced surgical teams. Robotic-assisted surgery has demonstrated particular utility in the management of neuroblastic tumors. Neuroblastomas, ganglioneuroblastomas, and ganglioneuromas frequently present challenges due to their location near critical vascular structures. In a study of 31 pediatric patients undergoing robotic-assisted resection for neuroblastic tumors, surgeons reported a high rate of complete tumor excision without complications. The three-dimensional visualization and precision control afforded by robotic systems allowed for meticulous dissection of tumors from adjacent vital structures, reducing the risk of complications and improving oncologic outcomes. Similarly, robotic-assisted surgery has been explored for the treatment of Wilms' tumor, a common pediatric renal malignancy. Traditional surgical approaches involve large incisions and extensive dissection, leading to prolonged recovery times. In contrast, robotic-assisted nephrectomy has been shown to reduce operative blood loss, shorten hospital stays, and improve cosmetic outcomes. A recent multicenter review of robotic-assisted Wilms' tumor resections reported successful tumor excision in all cases, with minimal complications and no instances of local recurrence at follow-up. These findings support the use of robotic-assisted techniques as a viable alternative to open surgery in select pediatric renal tumors. Beyond abdominal tumors, robotic-assisted surgery has been employed for thoracic malignancies, including mediastinal neurogenic tumors and thymic malignancies. The minimally invasive nature of robotic surgery is particularly beneficial in thoracic procedures, where avoiding large thoracotomies reduces postoperative pain and accelerates recovery. In a review of robotic-assisted thoracic tumor resections in pediatric patients, complete tumor excision was achieved in all cases, with only two instances requiring conversion to an open approach due to poor visualization. The study concluded that robotic-assisted thoracic surgery is a feasible and safe approach for select pediatric thoracic tumors, provided that patient selection is carefully considered. Despite these promising results, the adoption of robotic-assisted surgery in pediatric oncology has been met with challenges. One of the main limitations is the lack of standardized guidelines for patient selection and surgical technique. Given the rarity of pediatric cancers, the development of evidence-based recommendations has been slow, and most published studies rely on retrospective analyses and single-center experiences. The variability in tumor histology, patient age, and tumor location further complicates the establishment of universal criteria for robotic-assisted surgery in pediatric oncology. Another significant challenge is the cost associated with robotic-assisted surgery. The acquisition and maintenance of robotic systems are expensive, and the longer operative times compared to traditional laparoscopic procedures can increase hospital costs. However, proponents of robotic surgery argue that the reduced length of hospital stay, decreased complication rates, and improved long-term outcomes justify the initial investment. Moreover, as robotic technology continues to evolve and become more widely available, costs are expected to decrease, making robotic-assisted surgery a more accessible option for pediatric oncology patients. Training and experience are also critical factors in the successful implementation of robotic-assisted surgery in pediatric oncology. Unlike adult patients, pediatric patients present unique anatomical and physiological challenges that require specialized surgical expertise. Surgeons must undergo extensive training to develop proficiency in robotic techniques, and institutional support is necessary to establish dedicated robotic surgical programs. Some centers have adopted a mentorship model, where experienced robotic surgeons train less experienced colleagues using dual-console systems. This approach facilitates the safe adoption of robotic-assisted surgery and ensures that oncologic principles are upheld. The future of robotic-assisted surgery in pediatric oncology is promising, with ongoing research focusing on refining surgical techniques and expanding indications. Advances in image-guided surgery, such as fluorescence imaging and augmented reality, are expected to enhance tumor visualization and improve surgical precision. Additionally, the development of smaller robotic instruments tailored for pediatric patients may further optimize outcomes and broaden the applicability of robotic-assisted techniques. As robotic-assisted surgery continues to gain traction in pediatric oncology, multicenter collaborations and prospective studies will be essential to establish standardized protocols and validate long-term outcomes. The integration of robotics into pediatric oncology represents a significant advancement in surgical care, offering the potential to improve survival rates, reduce treatment-related morbidity, and enhance the overall quality of life for pediatric cancer patients. While challenges remain, the ongoing evolution of robotic technology and the growing body of clinical evidence support the continued exploration and refinement of robotic-assisted techniques in pediatric oncology. References: 1- Vatta F, Gazzaneo M, Bertozzi M, Raffaele A, Avolio L, Riccipetitoni G: Robotics-Assisted Pediatric Oncology Surgery—A Preliminary Single-Center Report and a Systematic Review of Published Studies. Front Pediatr. 9:780830, 2022 2- Blanc T, Meignan P, Vinit N, Ballouhey Q, Pio L, Capito C, Harte C, Vatta F, Galmiche-Rolland L, Minard V, Orbach D, Berteloot L, Muller C, Kohaut J, Broch A, Braik K, Binet A, Heloury Y, Fourcade L, Lardy H, Sarnacki S: Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors—A Nationwide Experience. Ann Surg Oncol. 29(2):1315-1326, 2022 3- Jacobson JC, Scrushy MG, Gillory LA, Pandya SR: Utilization of Robotics in Pediatric Surgical Oncology. Semin Pediatr Surg. 32(1):151263, 2023 4- Vinit N, Sarnacki S, Blanc T: Robotic-Assisted Laparoscopy in Pediatric Surgical Oncology: A Narrative Review. Transl Pediatr. 26;12(12):2256-2266, 2023 5- Svetanoff WJ, Carter M, Diefenbach KA, Michalsky M, DaJusta D, Gong E, Lautz TB, Aldrink JH: Robotic-Assisted Pediatric Thoracic and Abdominal Tumor Resection: An Initial Multi-center Review. J Pediatr Surg. 59(8):1619-1625, 2024 6- Blanc T, Taghavi K, Glenisson M, Capito C, Couloigner V, Vinit N, Sarnacki S: Robotic Surgery in Paediatric Oncology: Expanding Boundaries and Defining Relevant Indications. J Pediatr Surg. 60(3):162017, 2025 |
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