*4.7.5 Management for anorectal malformations*

Anorectal pull-through for anorectal malformations, with the robotic technology assists the pediatric surgeon by increasing dexterity and precision of movement. This is important in anorectal malformations surgery, where the dissection of the fistula and the pull-through of the rectum into the muscular complex are crucial to achieve continence in future. RAS permits easier closure of the fistula, improves reconstruction technique, and minimizes trauma to important surrounding structures, providing better visualization of the muscular complex. Robotic anorectal pull-through makes use of fundamental concepts learned from decades of highanorectal malformation open repair, and combines them with modern advances in surgical instrumentation and techniques [132].

**37**

efficiently [139].

*Robotic-Assisted Minimally Invasive Surgery in Children DOI: http://dx.doi.org/10.5772/intechopen.96684*

techniques most frequently performed in children [133].

USA). Their results were comparable in both approaches.

weighing more than 4 kg are more easily treated [15].

postoperative morbidity and mortality of patients [138].

**5.2 Congenital diaphragmatic hernia repair**

(8), and malignant tumor resection (5).

**5.1 Pulmonary lobectomy**

The global experience in thoracoscopic surgery in children is more than 30 years compared to robot-assisted thoracic surgery (RATS). The learning curve of thoracoscopy is longer compared to RAS. Thoracic MIS reduces the risk of thoracic and spinal deformities after lung resection in children. Lobectomy is one of the robotic

Early publications on RATS in children reported having performed cardiovascular techniques such as patent ductus arteriosus (PDA) closure and vascular ring section [134, 135]. Le Bret, et al. [134] in 2000, 56 children operated on for PDA surgical closure, 28 cases with thoracoscopy and 28 cases with robotic approach. They used the ZEUS robotic surgical system (Computer Motion, Inc., Goleta, CA.

Cundy et al. [13], in a systematic search in the literature of reported cases of robotic surgery in children of 2393 procedures, thoracic procedures accounted for 3.2% (77 surgeries and 12 different techniques), and the conversion rate was 10% in thoracic procedures. In this report, the five most frequent RATS procedures are: lobectomy (18), thymectomy (14), benign mass excision (9), diaphragmatic plasty

There are three series reported with a greater number of cases, each with 11 RATS in children (total 33), in order of frequency the procedures include: tumor masses resection (8), lobectomy (7), diaphragmatic plication (4), diaphragmatic plasty (3), esophageal atresia correction (3), bronchogenic cysts resection (3) and unique procedures of segmentectomy, esophageal duplication resection, pleural and lung biopsies, gastric tube/esophagoplasty and Heller myotomy. Overall, there were 6 (18%) conversions to open surgery in neonatal patients and (3) 9% postoperative complications. The neonatal thorax represents the greatest obstacle in the adaptation of the 5 or 8 mm robotic platform instruments [20, 133, 136]. In RATS, children

The most common RATS in children is lobectomy. The first publication on robotic lobectomy, including pediatric cases, was by Park et al. [137], in 2006. Series with few cases of segmental lung resections and lobectomies have been published with excellent results with conversions mainly on the first attempt [14, 15, 133, 136]. Addressing the disadvantages of RATS lobectomy, a prolonged total operative time was reported, but without having a negative effect, since it did not increase the

Congenital diaphragm abnormalities, including eventration and Morgagni and Bochdalek diaphragmatic hernias, have been successfully repaired through the use of conventional MIS. However, some reports have shown a high recurrence rate for some defects. Robotic surgery is the alternative to close diaphragmatic hernias more

Some authors prefer the thoracic approach to repair Bochdalek's diaphragmatic hernia, but infants weighing less than 2.5 kg are better treated with the abdominal approach. The author performed one case of Morgagni's diaphragmatic hernia and another case of Bochdalek's diaphragmatic hernia via the abdominal route. Robotic assistance allows the

surgeon to more easily reach this area to suture diaphragmatic defects [139].

**5. Thoracic robotic surgery**
