Pediatric Applications of Robotic Surgery

Abstract

The well-documented benefits of minimally invasive surgery include more rapid recovery, less patient discomfort, better cosmesis, and earlier hospital discharge. The price of these benefits is an increased demand on the operating surgeon's skill and the available technology. Endoscopic surgery in the pediatric patient offers several challenges above and beyond what a surgeon finds in the adult correlate. The body cavities are smaller, the impact of tremor and loss of dexterity are enhanced, and visibility is further limited. In recent reviews it has been noted that both the Zeus® (Computer Motion, Goleta, California) and da Vinci® (Intuitive Surgical, Mountain View, California) systems address many of the basic inconveniences of endoscopic surgery. By maintaining steady camera position, filtering tremor, scaling motion, and restoring lost degrees of freedom, these master-slave systems enhance the dexterity and, in turn, the capabilities of a robotically trained endoscopic surgeon. Enhanced surgeon dexterity could expand the field of currently possible minimally invasive procedures. Both systems also offer the possibility of telesurgery, allowing a robotic surgeon to operate on a patient at a distance. By playing the role of surgical assist, a robotic surgeon at a distance could even mentor a less-experienced local surgeon through a minimally invasive procedure that might otherwise pose an increased complication risk for the patient. The robot is a tool, nothing more, but in this capacity it has the potential to change how pediatric surgery is executed in the Unites States and the world today.