From precision to pediatric care: Evolution of robotic surgery in treating young patients

Dr Geeta Kekre, Consultant Paediatric Surgeon, Ruby Hall Clinic, Pune talks about the safety of robotic surgery for children in India

What is Robotic Surgery?

For much of history, surgery was performed through large incisions over the abdomen or chest. In the 1980’s, surgeons learned to perform these same surgeries through tiny incisions using what is called laparoscopic surgery. While laparoscopic surgery has many invaluable advantages, it also has some limitations which can be challenging to overcome. Robotic surgery is a tool that overcomes the limitations of laparoscopic surgery. It is minimally invasive surgery that allows far greater precision, finer movements and better depth perception.

A robotic surgical system consists of a patient-side cart which bears the robotic arms and instruments, and a console from which the surgeon moves and controls the instruments. Of note, the robot is incapable of performing any surgical task by itself. It is the surgeon who is completely in control of the movement of the instruments as well as the surgical decision making.

What are the advantages of robotic surgery compared to traditional surgery on children?

Robotic surgery for children has evolved rapidly over the last couple of decades. Most surgeries in children involve complex reconstructive work which entails the placement of fine sutures and performance of critical dissections. In many cases, due to the ergonomic limitations of conventional laparoscopy, these procedures needed to be performed via larger incisions on the abdomen. However, with the advent of robotics, these same procedures can be performed through minimal access techniques. In addition to having smaller incisions, minimal access techniques result in less blood loss, decreased post operative pain( and therefore, decreased requirement for pain killers), decreased risk of wound related complications, faster recovery, shorter hospital stays and faster return to activity.Also  robot may actually provide improved access to the target organ in hard to reach areas of the body.

How safe is robotic surgery for children in India?

The safety of robotic surgery in children at a well equipped centre has been well established. That said, it is imperative that these procedures are undertaken only at centres that have trained staff for robotic surgery and possess the skill sets required from the point of view of paediatric anaesthesia as well as paediatric surgery. Any and every surgery involves a certain calculated risk and the team is always prepared to convert to a laparoscopic or conventional surgery in case the situation demands.

What kind of surgeries can be performed on children using robotic technology in India?

Almost any intra-abdominal or intra-thoracic (chest) surgery can be performed using the robot. However, the greatest benefit of this technology is seen in reconstructive paediatric procedures such as pyeloplasties, ureteric reimplants, uretero-ureterstomies, Mitrofanoff channel constructions, choledochal cyst excisions, fundoplications, partial nephrectomies, pull-throughs for HIrschsprung’s Disease and hepatobiliary surgeries.

Are there any limitations to the use of robotic surgery for children in India?

Cost has often been cited by nay sayers as a limitation to the implementation of robotic surgery in India. However, in our experience, we have found a paradoxical effect on the cost to the patient. While robotic instruments and equipment are more expensive than laparoscopic ones, the overall cost of hospitalisation remains comparable to or even less than laparoscopy due to the decreased operating room time and decreased hospital stay. Moreover, studies from the West have shown a decreased economic impact on the family from robotic surgery as both parents are able to return to work faster than in conventional surgery.