Robotic-Assisted Surgery in Pediatric Gynecology: Preliminary Initial Outcomes

Abstract

Introduction:

Robotic-assisted surgery (RAS) has become widely used in adult gynecology but has not yet been widely used in pediatric patients. We report our initial experience in robot-assisted pediatric gynecologic surgery to determine its feasibility, safety, and limitations in children.

Methods:

A retrospective single-center study was performed among consecutive girls under 18 years who underwent gynecologic robotic-assisted procedures in our institution between 2012 and 2021. A three-arm robot (5 mm trocars) with one camera arm (12 mm trocar) was used in all cases by the same surgical team. Demographic data, type of robotic procedure, surgery time, complication rate, conversion rate to laparoscopic procedure, length of hospital stay (LOS), and postoperative complications were analyzed.

Results:

A total of 13 patients were included (median age 11.2 years; range of 2.5–17.4 years), who underwent robotic-assisted surgery for adnexal pathologies: five for ovarian teratoma resection, four for ovarian cystectomy, two for oophorectomy, one for bilateral salpingo-oophorectomy for gonadal dysgenesis, and one for hysterectomy in a patient with cerebral palsy and recurrent severe uterine bleeding. Median surgery time was 68 minutes (interquartile range [IQR]: 56–79 minutes). Intraoperative blood loss was minimal (median: 34 mL). Conversion to laparotomy was not necessary in any case. Median LOS was 1 day (IQR: 1–2 days). No intra- or postoperative complications occurred.

Conclusions:

Preliminary outcomes indicate that gynecologic RAS is effective and safely applicable in the pediatric population. However, it is still too early to conclude that it provides better clinical outcomes than traditional laparoscopic surgery. Further prospective, comparative studies are still needed.