title: Robot-assisted minimally invasive surgery for pediatric solid tumors: a systematic review of feasibility and current status.
abstract: BACKGROUND
  Open surgery remains the primary technique for resection of pediatric solid tumors despite the popularity of minimally invasive surgery (MIS) for oncological indications in adults and nononcological indications in children. Robot-assisted surgery offers technical and ergonomic advantages that might make MIS more achievable in this setting, permitting benefits for both the patient and surgeon. The aim of this study is to critically appraise the current status of robot-assisted MIS for pediatric solid tumors.
  
  
  METHODS
  A systematic search of multiple electronic literature databases was undertaken, supplemented by several relevant secondary sources.
  
  
  RESULTS
  A total of 23 publications met eligibility criteria, reporting 40 cases overall. Indications for surgery were widely varied, with over 20 different pathologies described. One-third of tumors were classified as malignant. Most procedures involved abdominal or retroperitoneal located tumors in adolescent patients (age range, 1-18 years). The collective complication and conversion rates were 10% and 12.5%, respectively. Oncological adverse events involved two isolated events of tumor spillage and residual disease. The evidence is limited to case reports and small case series only.
  
  
  CONCLUSIONS
  For the diverse and highly selective cases in this review, robot-assisted MIS seems safe and feasible. Current status is low volume, in a relatively static state of adoption, and without any apparent index pathology or procedure. The benefits of robot assistance seem well suited but remain unsubstantiated by evidence. Higher quality studies are needed to determine true safety and efficacy.
authors.affiliation: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Cundy
authors.affiliation: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
authors.forename: Hani J
authors.initials: HJ
authors.lastname: Marcus
authors.affiliation: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Clark
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Archie
authors.initials: A
authors.lastname: Hughes-Hallett
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Erik K
authors.initials: EK
authors.lastname: Mayer
authors.affiliation: Department of Paediatric Surgery, Leeds General Infirmary, Leeds, United Kingdom.
authors.forename: Azad S
authors.initials: AS
authors.lastname: Najmaldin
authors.affiliation: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
authors.affiliation: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000601:surgery*; D012371:Robotics / Q000706:statistics & numerical data*