**2.1 Characteristics**

*Latest Developments in Medical Robotics Systems*

implementation has been seen [3–6].

effectiveness [2].

published [13, 14].

in small children [14, 15].

lobectomy, respectively.

laparoscopic techniques [19].

utilized [11, 13, 30–35, 43–46].

robotic surgery [48].

0 to 15% [22, 49–51].

tion and preliminary assessment [13].

In 1994, the first robotic system used in the urological practice known as AESOP was introduced. Later, the evolution of these devices would bring the Zeus system and finally the Da Vinci system while continuously increasing their precision and

Since these initial reports, robotic surgery has seen widespread application within the adult population, especially in urologic and gynecologic procedures. As is often the case for new devices, technology, and therapeutic options in surgery, the application of robotic surgery for children has occurred more slowly than in adults. This caution is due in part to technical limitations with developing appropriately sized instruments for the pediatric patient; however, in recent years broader

In April 2001, Meininger et al. [7] published the first cases of RAS in children. The first of these two Nissen fundoplication procedures was reported as occurring in July 2000 [7–10]. Shortly afterward, the first robotic urological procedure in a child was undertaken in March 2002 by Peters et al. (personal communication, July 2002) who performed a pyeloplasty using the da Vinci® [11, 12]. Since then to date, more than 70 different surgical techniques have been

Currently, the only robotic system that is approved for pediatric use is the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) [7]. The da Vinci robot is well suited for children of all ages, including infants and newborns, using careful preoperative planning, this allows the da Vinci to be used for numerous procedures

The evolution of conventional laparoscopic surgery highlights the transitory stages that follow adoption and diffusion of surgical innovation [16–18]. RAS was introduced to the specialty of pediatric surgery following initial case reports in the early 21st century. Subsequently, this promising surgical technology has undergone a formative 10-year period of introduction, development, early dispersion, explora-

Cundy et al. [13], performed a 2013 systematic literature search for all reported

Due to the limitations of conventional laparoscopic surgery in pediatric patients, expert pediatric surgeons should only perform the more complex or reconstructive

There have been few reports that have been published about robotic general pediatric surgery [20–29]. Thus, far, the largest number of procedures and publications have been produced about robotic urological pediatric surgery [11–13, 30–45]. Trends in the literature indicate that pediatric RAS is continuing to be globally

The safety of RAS in children is reported to be similar to open procedures, and the outcomes are at least equivalent to conventional laparoscopy [47]. Robotic surgery on smaller children and infants require special considerations when discussing

Numerous case reports, case series, and comparative studies have unequivocally

In systematic investigations of databases of pediatric RAS, the global surgical conversion rate was 4.7% [22], and a net overall surgical conversion rate of 2.5% was reported [13]. In published studies of pediatric RAS, transoperative complications are infrequent, and in the postoperative period, the frequency varies from

demonstrated that robotic surgery in children is safe [13].

cases of RAS in children during an 11-year period. During this time, 2,393 procedures in 1,840 patients were reported and the most prevalent gastrointestinal, genitourinary, and thoracic procedures were fundoplication, pyeloplasty, and

**28**

In RAS robotic devices are used, such as the Da Vinci system from Intuitive Surgical, which has a miniaturized camera and the surgeon operates seated at a console close to the patient (telesurgery), with three-dimensional and magnified images of the operative field, and manipulates articulated instruments controlled by their hands and feet; It is supported by a second surgeon positioned next to the patient at the exposure of the operative field, with retraction, suction and exchange of instruments in the arms of the robot. There is greater precision than in open surgery and conventional laparo-thoracoscopic surgery [52].
