title: Five millimetre-instruments in paediatric robotic surgery: Advantages and shortcomings.
abstract: OBJECTIVE
  The study was designed to assess the utility and controversies surrounding the usage of 5-mm instruments in paediatric robotic surgery. Adequate, delicate instruments for surgery in very narrow spaces are still lacking.
  
  
  METHODS
  Thirty children underwent elective abdominal robotic surgery. Working sites, assembly and operative time, hospital stay, advantages, complications and shortcomings are reported.
  
  
  RESULTS
  Interventions were performed in the following anatomical sites: 11 upper abdominal, nine pelvic, ten renal procedures. The majority of procedures required two operative trocars. A 2-3 mm accessory port was necessary for operations in the renal area and upper abdomen. The ports had to be placed at least 3 cm from the costal margins and superior iliac spines and at an angle of at least 130° with respect to the camera trocar. This configuration allowed intra-corporal knotting, vessel ligation and dissection with instruments in the inverted position. Operative times and hospital stays were similar to those reported for 8 mm-instruments.
  
  
  CONCLUSIONS
  The use of 5-mm instruments was advantageous in renal and pelvic sites. The benefits in upper abdominal surgery need further evaluation, particularly in patients weighing <10 kg. Smaller sized instruments with high endowrist dexterity would resolve the problems encountered in paediatric robotic-assisted surgery using 5-mm instruments.
authors.affiliation: Department of the Mother and Child Health, Paediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo and Department of Clinical-Surgical, Diagnostic and Paediatric Sciences University of Pavia , Pavia , Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Pelizzo
authors.forename: Ghassan
authors.initials: G
authors.lastname: Nakib
authors.forename: Piero
authors.initials: P
authors.lastname: Romano
authors.forename: Luigi
authors.initials: L
authors.lastname: Avolio
authors.forename: Simonetta
authors.initials: S
authors.lastname: Mencherini
authors.forename: Elisa
authors.initials: E
authors.lastname: Zambaiti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Raffaele
authors.forename: Timothée
authors.initials: T
authors.lastname: Stoll
authors.forename: Nicolò
authors.initials: N
authors.lastname: Mineo
authors.forename: Valeria
authors.initials: V
authors.lastname: Calcaterra
mesh_terms: D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000295:instrumentation*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D010388:Pelvis / Q000601:surgery; D011183:Postoperative Complications; D065287:Robotic Surgical Procedures / Q000295:instrumentation*; D014551:Urinary Tract / Q000601:surgery
keywords: Robotic-assisted surgery; instruments; paediatric