LEEDS EXPERIENCE

Short and long term complications of robotic laparoscopy in children: a prospective study (Presented in British Association of Paediatric Surgery 2019)

Dona, T Cundy, N Alizai , A Najmaldin (Leeds General Infirmary)

Aim: To present complications of robotic assisted laparoscopy in a large series of children

Methods: All children who underwent robotic assisted laparoscopic surgery under the care of two laparoscopic surgeons between March 2006 and May 2017 were included. Three arms of the da Vinci system and an open technique laparoscopy were used in all cases (12 or 8mm optic and 8 or 5mm working ports). An additional laparoscopic port and a retractor were used when necessary. Theatre setup/team changed not infrequently throughout the study period. All patients had regular follow. Data was collected prospectively.

Results: There were 536 procedures in 528 children (5 re-do, 2 bilateral, 6 concomitant). The procedures were urological in 51.5%, hepatobiliary and spleen 26.1% and gastrointestinal 22.4% (26 different procedures).The median age was 7.3 years (4 weeks – 16 years, 7% less than one, smallest 4.2kg). 18.6% had a significant comorbidity, 15.9% previous surgery and abdominal scarring, and 5.8% concomitant non-robotic procedures. The procedure was converted in 6% (32), none for surgical complications. In theatre complications occurred in 1.3 %( 7) – of these, 3 were minor, 3 gastrostomy related, 1 damaged vagus nerve. Early postoperative complications occurred in 3.9% (21) – of these, 6 required further surgery ( 2 laparoscopy / laparotomy, 4 endoscopy) and the remainder were treated conservatively. Throughout the study period 2.4% (13) developed complications . These included redo-surgery 6, other surgical procedures 3, endoscopy 3, asymptomatic renal cyst 1. The rates and nature of complications did not correlate significantly with the patients age, timing of surgery or operator.

Conclusions: in the hands of laparoscopic surgeons, complications of paediatric robotic assisted surgery appears low even during the learning curve.

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