Robotic lobectomy in children with severe bronchiectasis: A worthwhile new technology

• Published in: Journal of pediatric surgery 2021-09, Vol.56 (9), p.1606-1610
• Main Authors: Durand, Marion, Musleh, Layla, Vatta, Fabrizio, Orofino, Giorgia, Querciagrossa, Stefania, Jugie, Myriam, Bustarret, Olivier, Delacourt, Christophe, Sarnacki, Sabine, Blanc, Thomas, Khen-Dunlop, Naziha
• Format: Article
• Language: English
• Subjects: Congenital lesions; Lobectomy; Pediatric; Robotic-assisted thoracic surgery; Video-assisted thoracic surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2020.11.009

•Robotic lobectomy is safe and reproducible in children with severe bronchiectasis.•Four-arm robotic lobectomy in children needs an adult-adapted technique.•In complex lobectomies, robotic surgery was associated with no conversion.•Advantages of robotic approach are 3D vision and three hand-wrist instruments. Lobectomy is required in children affected by non-responsive, symptomatic, localized bronchiectasis, but inflammation makes thoracoscopy challenging. We present the first published series of robotic-assisted pulmonary lobectomy in children with bronchiectasis. Retrospective analysis of all consecutive patients who underwent pulmonary lobectomy for severe localized bronchiectasis (2014–2019) via thoracoscopic versus robotic lobectomy. Four 5 mm ports were used for thoracoscopy; a four-arm approach was used for robotic surgery (Da Vinci Surgical Xi System, Intuitive Surgical, California). Eighteen children were operated (robotic resection, n = 7; thoracoscopy, n = 11) with infected congenital pulmonary malformation, primary ciliary dyskinesia, and post-viral infection. There were no conversions to open surgery with robotic surgery, but five with thoracoscopy. Total operative time was significantly longer with robotic versus thoracoscopic surgery (mean 247 ± 50 versus 152 ± 57 min, p = 0.008). There were no significant differences in perioperative complications, length of thoracic drainage, or total length of stay (mean 7 ± 2 versus 8 ± 3 days, respectively). No blood transfusions were required. Two thoracoscopic patients had a type-3 postoperative complication. Pediatric robotic lung lobectomy is feasible and safe, with excellent visualization and bi-manual hand-wrist dissection – useful properties in difficult cases of infectious pathologies. However, instrumentation dimensions limit use in smaller thoraxes. [Display omitted]