title: Assessment of paediatric thoracic robotic surgery.
abstract: OBJECTIVE
  Many studies have reported that robotic-assisted surgery is safe and feasible for paediatric cases. However, very few paediatric thoracic robotic cases have been described. The aim of this study was to share our preliminary experience with robot-assisted thoracic surgery (RATS).
  
  
  METHODS
  We reviewed our first, consecutive thoracic robotic procedures between January 2008 and December 2013. Data describing the perioperative and intraoperative periods were prospectively collected in two surgical paediatric centres and then retrospectively analysed. Operation time, completion rate, length of hospitalization and postoperative complications were compared with thoracoscopic results in the literature.
  
  
  RESULTS
  Eleven patients were operated on with the robot, and this included operations for oesophageal atresia (3), mediastinal cyst (4), diaphragmatic hernia (2), oesophagoplasty (1) and oesophageal myotomy (1). The mean age at surgery was 72 (range 0-204) months, and the mean weight was 24.4 (range 3.0-51.5) kg. Three of the operations were converted to thoracotomies. The total operation time was 190 (120-310) min, and the average length of hospital stay was 13 (3-35) days. RATS offers similar advantages to thoracoscopy for mediastinal cyst excision in patients weighing more than 20 kg. Appropriate patient positioning and trocar placement were necessary for neonatal patients and thereby resulted in longer preparation times. Despite cautious adjustments, technical feasibility was reduced for low-weight patients.
  
  
  CONCLUSIONS
  These data support mediastinal cyst excision as a suitable indication for larger children. Currently, there is a lack of evidence that lower weight children, and particularly neonates, are good candidates for RATS.
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, Limoges, France q.ballouhey@gmail.com.
authors.forename: Quentin
authors.initials: Q
authors.lastname: Ballouhey
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital de Clocheville, Tours, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Villemagne
authors.affiliation: Service d'anesthésie pédiatrique, Hôpital des Enfants, Limoges, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cros
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, Limoges, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Vacquerie
authors.affiliation: Service d'anesthésie pédiatrique, Hôpital des Enfants, Limoges, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bérenguer
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital de Clocheville, Tours, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Braik
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital de Clocheville, Tours, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Szwarc
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, Limoges, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Longis
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital de Clocheville, Tours, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Lardy
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, Limoges, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fourcade
mesh_terms: D002648:Child; D002675:Child, Preschool; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D012371:Robotics; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: Children; Congenital; Robotic surgery; Thoracoscopy