title: A comparison of robotic surgery in children weighing above and below 15.0 kg: size does not affect surgery success.
abstract: BACKGROUND
  Initial results in pediatric surgery are encouraging, particularly in the field of pediatric urology. However, there is limited experience with its application in infants and neonates. The aim of this study was to compare the feasibility and safety of robotic-assisted surgery in two populations of children, one weighing less and one weighing more than 15.0 kg.
  
  
  METHODS
  A multicentric study was performed comparing the success of robotic-assisted surgery in patients who weighed less than 15.0 kg (group A) to patients heavier than 15.0 kg (group B), with a total of 178 procedures performed between January 2008 and December 2012. Data concerning the perioperative and intraoperative periods were prospectively collected and retrospectively analyzed.
  
  
  RESULTS
  The success of robotic-assisted surgery was compared between group A (62 patients, 11.1 kg) and group B (116 patients, 30.2 kg), with a mean follow-up of 37 months (16-75 months). The conversion rate was superior for group A (5 vs. 2%) and involved three neonatal thoracic procedures. Focusing on three common procedures for both groups (pyeloplasty, partial nephrectomy, and fundoplication), the amount of time for set up was longer for group A (p < 0.05). We found no statistical differences in the mean total operative time and length of hospital stay. The postoperative follow-up revealed similar results for both groups.
  
  
  CONCLUSIONS
  Cautious adjustments in the patient positioning and trocar placement were necessary in a subset of this pediatric population. For these three particular procedures, with the exception of the longer set up time, the results between the two groups were comparable. These data support the feasibility of robotic-assisted surgery for small children, despite the lack of dedicated instruments.
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France, q.ballouhey@gmail.com.
authors.forename: Quentin
authors.initials: Q
authors.lastname: Ballouhey
authors.forename: Thierry
authors.initials: T
authors.lastname: Villemagne
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cros
authors.forename: Caroline
authors.initials: C
authors.lastname: Szwarc
authors.forename: Karim
authors.initials: K
authors.lastname: Braik
authors.forename: Bernard
authors.initials: B
authors.lastname: Longis
authors.forename: Hubert
authors.initials: H
authors.lastname: Lardy
authors.forename: Laurent
authors.initials: L
authors.lastname: Fourcade
mesh_terms: D001835:Body Weight; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D056888:Patient Positioning; D057234:Preoperative Period; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures