title: Da Vinci Robotic Surgery in a Pediatric Hospital.
abstract: BACKGROUND
  Since the use of robotic surgery (RS) revolutionized some adult surgery procedures such as radical prostatectomy, it has been progressively and increasingly introduced in pediatric surgery. The aim of this study is to evaluate how the Da Vinci®Si HD technology impacts a pediatric public hospital and to define the use of a robotic system in pediatric surgery.
  
  
  METHODS
  We prospectively included patients older than 6 months of age undergoing RS or conventional minimal access surgery (MAS): Study period ranges between February 2015 and April 2016. Surgical indications were defined after a detailed disease-specific diagnostic work-up. We analyzed surgical outcomes and the most relevant economic aspects. The 30-day postoperative complications were evaluated and retrospectively collected in an electronic database.
  
  
  RESULTS
  From February 2015 to April 2016, we performed 77 procedures with RS and 84 with conventional MAS in patients with a median age of 77 and 98 months at surgery and a median weight of 20 and 23 kg, respectively. Median operative times were 130 and 109 minutes, respectively. We observed 9.1% of complications in the RS group and 6% in the MAS group and the difference was not statistically significant. Of note, 8 out of 77 RS procedures would have been performed with open classic surgery in case of conversion or failure of RS.
  
  
  CONCLUSIONS
  This initial experience confirms that RS is as safe and effective as conventional MAS. A number of selected procedures performed with RS would only benefit from this approach, as it is not suitable for conventional MAS. Although economically demanding, in particular for a pediatric hospital, we firmly believe that centralization of care would allow pediatric surgeons adopting RS to perform complex reconstructive surgical procedures with great advantages for the patients and a minimal increase in overall costs for the health system.
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .|2 Pediatric Surgery Unit, University of Genoa , Genova, Italy .
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Alessio
authors.initials: A
authors.lastname: Pini Prato
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Barbara
authors.initials: B
authors.lastname: Razore
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .|2 Pediatric Surgery Unit, University of Genoa , Genova, Italy .
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Leonelli
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .|2 Pediatric Surgery Unit, University of Genoa , Genova, Italy .
authors.forename: Luca
authors.initials: L
authors.lastname: Pio
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Stefano
authors.initials: S
authors.lastname: Avanzini
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .|2 Pediatric Surgery Unit, University of Genoa , Genova, Italy .
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boscarelli
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Paola
authors.initials: P
authors.lastname: Barabino
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Nicola Massimo
authors.initials: NM
authors.lastname: Disma
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Clelia
authors.initials: C
authors.lastname: Zanaboni
authors.affiliation: 3 Pediatric Surgery Unit, University of Salerno , Fisciano, Italy .
authors.forename: Alfredo
authors.initials: A
authors.lastname: Garzi
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .|2 Pediatric Surgery Unit, University of Genoa , Genova, Italy .
authors.forename: Sofia Paola
authors.initials: SP
authors.lastname: Martigli
authors.affiliation: 4 Department of Urology, Humanitas Clinical and Research Center, Humanitas University , Rozzano, Italy .
authors.forename: Nicolò Maria
authors.initials: NM
authors.lastname: Buffi
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Rosati
authors.affiliation: 1 Pediatric Surgery Unit, Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Paolo
authors.initials: P
authors.lastname: Petralia
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000191:economics; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D055815:Young Adult
keywords: minimally invasive surgery; pediatric; pediatric robotic surgery; surgical robotics