An Audit of Robot-Assisted Minimally Invasive Surgeries in Children: Early Experience from a Tertiary Care Center in India.

Background: Over the last decade, a significant rise in pediatric robot-assisted minimally invasive surgeries has been observed. Apart from the urological surgeries in children, robot assistance for complex nonurological reconstructions is being explored increasingly. This study highlights our preliminary experience of robot-assisted minimally invasive surgeries in children. Materials and Methods: An ethical waiver was given by the Institute's Ethics Committee in view of the retrospective nature of the study and all procedures being performed as a part of the routine care. A retrospective analysis was done to include all the pediatric robot-assisted surgeries performed at our hospital over a 4-year period (January 2017-January 2021). The surgeries were categorized based on the involved organ system and the total study duration was divided into four 12-month time periods. A comparison of the total number of surgeries done in each time period was also done. A log of the surgeon's console duration for each surgery was also kept. Results: A total of 65 patients, with the majority (50/65; 77%) undergoing reconstructive surgeries for anomalies within the genitourinary system, were included. Almost two-thirds of the total surgeries were technically complex. The number of procedures performed during the four 12-month time periods was 18, 18, 15, and 14. The average (range) surgeon's console time was 95 minutes (45-327 minutes) and showed a progressive improvement with the passage of time. Only 1 patient required conversion to an open approach, and none had major complications during the postoperative period. Conclusion: Our early experience of robot-assisted minimally invasive surgeries in children reaffirms its safety and feasibility in complex reconstructive surgeries. It also highlights the advantages of robot assistance in smaller children with nonurological anomalies.

A Comparative Study of the Ergonomic Risk to the Surgeon During Vesicoscopic and Robotic Cross-Trigonal Ureteric Reimplantation.

Background: Maintenance of the body posture and precise repetitive movements during minimally invasive surgeries predispose the surgeons to the risk of musculoskeletal disorders (MSDs). The present study was designed to estimate the ergonomic risk of MSDs in a single surgeon while performing vesicoscopic ureteric reimplantation. Materials and Methods: All children with primary vesicoureteric reflux (VUR) undergoing vesicoscopic ureteric reimplantation through the laparoscopic (Group 1) or robotic (Group 2) approaches from July 2015 to October 2019 were included. Data, including age at the time of surgery, gender, the severity of VUR (grade), number of ureters involved (unilateral or bilateral), and procedural details, were recorded. Rapid Entire Body Assessment (REBA) tool was used for the ergonomic risk assessment of each procedure. The REBA scores were graded as negligible (1), low (2-3), medium (4-7), high (8-10), and very high (11 or more). The risk index was considered as normal (1 or less) and high (>1). The ergonomic risk associated with both approaches was compared. Results: A total of 16 patients (Male:Female = 9:7) were included in the present study. Groups 1 and 2 had 11 and 5 patients, respectively. The average (range) age of the children belonging to Group 1 was significantly lesser than Group 2 (3 versus 7.5 years; P = .0004). The average duration of surgery was significantly longer in Groups 1 versus 2 (P = .03). The average REBA scores associated with the laparoscopic and robotic approaches were 13 and 5, respectively (P = .0006). The risk indices in both approaches were 3.25 and 1.25, respectively. Conclusion: In a limited cohort of patients, we observed an overall high risk of MSD to the surgeon while performing vesicoscopic ureteric reimplantation. The associated ergonomic risk was significantly less with the robotic (medium risk category) versus laparoscopic approach (very high risk category).