Pediatric robotic surgery: early assessment.
OBJECTIVE
This article reviews the evidence regarding the feasibility, safety, benefits, limitations, and costs of robotically assisted surgery in children, evaluates how the technology compares with other pediatric surgical techniques, and provides insights about the near and more-distant future of the technology.


METHODS
The peer-reviewed medical pediatric literature was searched for studies that provided evidence of the feasibility and safety of robotic surgery in children and for studies that compared pediatric robotic surgery with conventional laparoscopic surgery or open surgery.


RESULTS
A total of 8 case series and 5 studies comparing robotic surgery with open or conventional laparoscopic surgery met the selection criteria for review. A few small studies that focused on rare complex surgical procedures also were reviewed. All studies were designed to evaluate the feasibility and safety of robotic surgery in children. None of the studies was randomized, and some studies had a retrospective design. These studies demonstrated that a number of routine, robotically assisted, laparoscopic and thoracic procedures were feasible and safe when performed by surgeons experienced in the technique, although robotic surgery did not provide superior outcomes, compared with traditional laparoscopic and open surgery. The advantages of the robotic system were best seen in complex procedures that involved areas that were difficult to access and in procedures in which dissection of delicate, anatomic structures was required.


CONCLUSIONS
Robotic surgery is feasible and safe for a number of pediatric surgical procedures, but evidence that it offers better clinical outcomes than conventional open or laparoscopic techniques is lacking.
van Haasteren
Goedele
G
Hayes Inc, Independent Health Technology Assessment Company, Lansdale, Pennsylvania 19446, USA. gvhaasteren@hayesinc.com
Levine
Susan
S
Hayes
Winifred
W
D049628:Body Size; D002648:Child; D003430:Cross-Sectional Studies; D004374:Ductus Arteriosus, Patent / Q000601:surgery; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D018662:Fundoplication / Q000295:instrumentation; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology; D007682:Kidney Pelvis / Q000601:surgery; D010535:Laparoscopy; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008866:Microsurgery / Q000295:instrumentation; D009873:Operating Rooms; D010043:Outcome and Process Assessment, Health Care; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D012371:Robotics / Q000191:economics / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000191:economics / Q000295:instrumentation*; D013673:Technology Assessment, Biomedical; D013996:Time and Motion Studies