ROBOTIC-ASSISTED ONCOLOGIC SURGERY IN CHILDHOOD AND ADOLESCENCE: SHOULD WE DO IT?

Background Minimally invasive surgery (MIS) has gained popularity in the diagnostic and staging phases of solid tumors in children, but its therapeutic role remain controversial for the lack of confidence regarding respect of safe oncological principles with this more demanding approach in limited spaces. Robotic-assisted surgery, with its technical and ergonomic advantages for the surgeon, could represent a valid solution to the limitations of therapeutic standard MIS in oncologic surgery, but very limited data are available in the literature. We present our single Centre experience. Materials and methods We started our pediatric robotic surgical program from June 2015, in the setting of a general hospital. During this period, overall 21 robotic-assisted procedures were performed in 12 female and 9 male patients, mainly gastro-esophageal procedures (9 cases: 6 GERD, 1 achalasia, 1 double gastric duplication cyst, 1 hiatal hernia) and urological procedures (6 cases: 4 hydronephrosis, 1 dysplastic kidney, 1 caliceal cyst). Our robotic program was applied by a team without previous experience in MIS approach to the above mentioned conditions. We evaluated retrospectively oncologic cases performed within this program. Results In the examined period, 4 out of 21 (19%) robotic-assisted procedures were performed successfully for oncologic conditions, without intraoperative complications (table). All patients were female (age range 10–14 yrs, weigth range 38–58 kg). Treated conditions were a 25-mm left ovarian dermoid cyst (console time 180’, enucleated with minimal spillage), a 35-mm Frantz’s tumor of the pancreatic body (enucleated without complication with a console time of 240’), a left 40x32 mm pheocromocytoma (adrenalectomy, console time 210’) and a left 32x27x33 mm parasurrenalic ganlioneuroma, completely removed with adrenal preservation (console time 230’). Length of hospital stay varied from 3 to 10 p.o. days. In the follow up (range 4–15 months), no recurrence was evidenced Conclusions Our initial and limited experience suggests that robotic-assisted procedures are safe, feasible and respectful of surgical oncologic principles in childhood, at least for benign or locally aggressive conditions in older children or adolescents. Given the ergonomic advantages for the surgeon that enhance its operative abilities, robotic-assisted surgery could „democratize” demanding MIS procedures also for oncologic conditions, making it accessible with a shortened learning curve also to surgeons with limited MIS experience. However, larger and high-quality studies are needed prior to define robotic-assisted approach as the gold standard in this setting, but difficult to perform for conditions relatively rare in childhood.