On average, nearly four million annual surgical procedures in the U.S. are completed on pediatric patients. Despite this growing figure, surgical innovation has focused heavily on technologies for treating adults — until now. With advancements on the horizon, new features of robotic-assisted surgery are being developed to address the unique obstacles of pediatric surgery.
In recent years, robotic platforms have been employed in pediatric patients; however, they used relatively large instruments. As we’ll explore below, smaller instrument sizes are now becoming more prevalent, and surgeons performing pediatric procedures may benefit significantly from the precision and dexterity of robotics platforms.
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Advantages of smaller incision size
Beyond aesthetics, smaller incisions can shorten recovery time and cause less pain for the patient. As opposed to making one large abdominal incision, multiple smaller incisions can reduce both blood loss and recovery time. It is not only the size of the incision, but also the proportion compared to overall abdominal surface that impacts pain, tissue damage, and length of the hospital stay.
Incision size matters to all patients, but more specifically to pediatric patients. As children continue to grow, their incision scars grow with them and proportionally increase in size over time. We also must consider that pediatric patients have different pain thresholds than adults and may not tolerate the same pain medications. This places a premium on minimizing the initial incision with the smallest possible instruments in robotic procedures.
Today’s most robust robotic platforms offer 3mm and 5mm instrumentation, allowing for more increased dexterity and control. This enables surgeons to navigate delicate anatomical structures as well as access hard-to-reach areas. Not only are these instruments less invasive, but they enable smaller incision sizes and improved patient outcomes.
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Unique challenges and complexities of pediatric surgery
Incision size is not the only factor pediatric surgeons must consider. The anatomy of young patients can make surgery extremely challenging as surgeons have limited access to organs and a smaller working space.
As opposed to adult patients whose bodies are larger and fully developed, it is difficult to anticipate anatomical issues during a pediatric procedure. Children’s bodies are not simply smaller versions of adults, but are also more delicate. Their organs are developing and their tissue and blood vessels can be more fragile. These challenging cases may benefit from the increased precision offered by robotically-enabled laparoscopic approaches.
Surgeon benefits
While many features of robotic-assisted surgery are aimed at improving patient outcomes, there are also various benefits for surgeons themselves. Meticulous pediatric procedures can be taxing, and long hours on their feet, strenuous movements, and repetitive actions can leave a surgeon exhausted. In fact, 68% of surgeons report experiencing generalized pain following procedures, with minimally invasive surgeons reporting the most amount of pain, fatigue, and numbness.
Many robotic platforms allow for the surgeon to be seated in an ergonomically comfortable position throughout the procedure. This allows for a range of adjustments to customize the console setup according to the surgeon’s preferences. Additionally, some systems offer an open cockpit design, which enables easy access to the patient and clear communication between the surgeon and staff. With a range of ergonomic options, robotic surgery can make strenuous procedures easier – and even extend the surgeon’s career.
Benefits of digital surgery
Surgeons need real-time information to make informed decisions, navigate challenging anatomy, and reduce variability. In addition to improving upon the basic mechanics of traditional surgery, the advanced features on a robotics platform can help surgeons provide a new standard of care. For example, eye tracking, a software feature available on newer platforms, follows a surgeon’s eye movements and repositions the surgical camera inside the patient. This provides the OR team with a stable and optimum view of the patient’s anatomy.
One of the most unique features in newer robotic platforms is haptic feedback, or physical sensation. Not only does it provide a more natural sensation of pressure when completing surgical tasks, but it allows the surgeon to feel when they are in contact with anatomy that can be potentially damaged or injured by instrument movements. Additional features available on some newer platforms include digital measurements and tagging – both of which provide visual instruction for enhanced communication and coordination of the surgical team.
From what we’ve seen, pediatric patients can clearly benefit from robotic-assisted surgery. With the many advantages of robotics, it is time for pediatric patients to garner the same attention and technology development that adult patients have benefitted from for decades.
Photo: FatCamera, Gett. Images
As VP of Medical Affairs and Professional Education, Dr. Ed Chekan leads the company’s clinical, training and education, and scientific matters. Prior to joining Asensus, Dr. Chekan held positions in Medical Affairs within Ethicon Endosurgery and Teleflex. He worked as a consultant for several strategic and start up medical device companies where he led training and education programs and developed new products. Dr. Chekan completed his minimally invasive surgery fellowship at Duke University, is certified in General Surgery by the American Board of Surgery and holds an adjunctive position within the Duke Department of Surgery.
