**8. Author's experience in robotic surgery**

From March 2015 to January 2021, since the beginning the prospective registry of the casuistry has been carried out. We have performed 258 robot-assisted laparoscopic and thoracoscopic surgeries (RALTS) in 227 patients (224 children and 3 adults), in a public hospital and two private hospitals in Mexico City**.** The demographic data of the patients are, in relation to gender, 52.4% male and 47.6% female. The average and range of age, weight and height of the patients were, age 79.5 months (2 to 204), weight 26.8 kg (4.4 to 102) and height 114.5 cm (55 to 185), the smallest patient was 2 months old, 4.4 kg in weight and 57 cm in height, a left pyeloplasty was performed. The adult patients were 31, 63 and 64 years old.

We grouped our RALTS into gastrointestinal-hepatobiliary 123 (47.68%), urological 117 (45.35%), thoracic 10 (3.87% and oncological 8 (3.1%). We have

**41**

**9.1 Planning**

and carcinoid tumor.

tion [114] and in thoracic surgery [133].

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

follow-up is 40 months.

performed 46 different techniques, globally our conversion rate is 3.1%, the

cations 4%. In this group of RAS 14 different techniques were performed.

10%. In this group of RAS 5 different techniques were performed.

**9. Implementation of a pediatric robotic surgery program**

In the robotic oncological surgery group, the techniques performed were adrenalectomy 2 (for adenoma and another for pheochromocytoma) and single techniques of, anterior mediastinal teratoma resection, Ewing tumor resection, Wilms tumor stage 3 resection in horseshoe kidney, partial gastrectomy for carcinoid tumor, retroperitoneal lipoma resection and conservative resection of ovarian cyst. In this robotic cancer surgery group, the conversion rate was 12.5%, and there were no complications. In this group of RAS 8 different techniques were performed. The cases of adult patients were pheochromocytoma, adrenal adenoma

Previously, we published our experience with RALTS, the first 186 surgeries [14], the first 4 cases of choledochal cyst resection [109], redo Nissen fundoplica-

The success of a pediatric robotic surgery program (PRSP) depends on a wellstructured plan. Implementing a PRSP requires institutional support and requires a

performed were: pyeloplasty 26 (22.2%), ureteral reimplantation 21 (17.94%), nephrectomy 20 (17.1%), Mitrofanoff operation 8 (6.8%), nephroureterectomy 7 (6%), ureterostomy de-derivation and ureteral neo-reimplantation 5 (4.3%), nephro-cystolithotomy 5 (4.3%), varicocelectomy 5 (4.3%), release of extrinsic UPJ obstruction 4 (3.4%), inguinal hernioplasty 3 (2.56%) and various techniques 13 (11.1%) of single cases, ureteroureterostomy, augmentation cystoplasty, bladder neck closure, heminephroureterectomy, perirenal abscess drainage, colostomy closure, enterovesical fistula closure, Mitrofanoff review, ureterostomy and ureteropyelography, bilateral gonadectomy, duplicated ureter ureterostomy, hysterosalpingectomy, bladder wall biopsy. In this robotic urologic surgery group, the conversion rate was 0.85%, intraoperative complications 0.85%, and postoperative complications 1.7%. In this group of RAS 20 different techniques were performed. In the robotic thoracic surgery group, in order of frequency, the techniques performed were: lobectomy 4 (40%), diaphragmatic plication or plasty 4 (40%), a bronchogenic cyst resection (10%) and a pleural biopsies (10%). In this robotic thoracic surgery group, the conversion rate was 20% and postoperative complications

From the robotic urological surgery group, in order of frequency, the techniques

hemotransfusion rate is 4.2%, the mean postoperative stay is 2.5 days, and the mean

From the group of gastrointestinal-hepatobiliary robotic surgery, in order of frequency, the techniques performed were: primary fundoplication 50 (41.67%), redo fundoplication 20 (15.83%), gastrostomy 17 (14.16%), cholecystectomy 14 (11.67%), biliodigestive 7 (5%), being 5 resections of choledochal cysts with hepaticojejunostomy, a Kasai operation and a hepaticojejunostomy to manage the lesion of the left hepatic duct. Splenectomy 6 (5%), Malone operation 2 (1.67%) and various techniques 7 (5%), of single cases, duodenoplasty and adhesiolysis, gastric trichobezoar extraction, drainage of recurrent retrohepatic abscess after appendectomy, gastric antrum membrane resection, gastrojejunostomy de-derivation, and Ladd's Cure. In this group of gastro-intestinal-hepatobiliary robotic surgery, the conversion rate was 3.25%, intraoperative complications 1.6%, and postoperative compli*Latest Developments in Medical Robotics Systems*

tory or cardiovascular physiology [104].

tracheostomy. Conversion index was 9.8% [166].

**8. Author's experience in robotic surgery**

**7. Otorhinolaryngology**

other patients survived without a tumor [164].

is available, ovarian tumors are a suitable entry procedure [128].

ing placement of gastrostomy tubes and ovarian transposition [104].

resections can guarantee adherence of the RAS to oncological principles.

with liver metastasis 41 months after surgery and died 63 months after surgery. All

Robotic gynecological surgery in girls with ovarian disease, the ideal is to maintain the morphology of the ovary, which is beneficial for the recovery of postoperative ovarian function, especially in benign diseases. In centers where robotic surgery

Robotic surgery can also be used in supportive care in pediatric oncology includ-

The fundamental oncological principles of no tumor spillage and total resection of tumor margins can be adhered to by RAS; a specific concern being the lack of haptics having an impact on the surgeon's ability to differentiate cancerous from healthy tissue. However, it has been noted that the loss of tactile feedback is, very well compensated for by the excellent optical system [158]. Cancer patients are necessarily followed for recurrences, and only long-term prospective studies of robotic

Contraindications in children for MIS in tumors, including robotic surgery, are large or fragile tumors that carry a high risk of fracture and tumor spillage, significant adhesions from previous operations, and significant deterioration of respira-

Pediatric robotic surgery has been used least frequently in otorhinolaryngology [72]. Until now, the majority of RAS applications in otorhinolaryngology is a transoral approach, particularly useful in masses of the base of the tongue. Open surgery can facilitate access to the oropharyngeal region, including the base of the tongue, but can lead to the morbidity of splitting the lip and jaw or require pharyngotomy. As a result, the robotic transoral approach is being used [165]. In the near future, we believe that transoral robotic surgery may become the gold standard. In a publication of pediatric cases of robotic transoral surgery, with 41 patients, with age between 2 months and 19 years, the techniques were, lingual tonsillectomies (16), lingual and lingual based tonsillectomies (9), 2 malignant diseases in the oropharynx (high-grade undifferentiated sarcoma and biphasic synovial sarcoma), a thyroglossal duct cyst at the base of the tongue, laryngeal cleft cysts (11), a posterior glottic stenosis, and a surgery for congenital true vocal cord paralysis. A minor intraoperative complication occurred. No patient required postoperative

From March 2015 to January 2021, since the beginning the prospective registry of the casuistry has been carried out. We have performed 258 robot-assisted laparoscopic and thoracoscopic surgeries (RALTS) in 227 patients (224 children and 3 adults), in a public hospital and two private hospitals in Mexico City**.** The demographic data of the patients are, in relation to gender, 52.4% male and 47.6% female. The average and range of age, weight and height of the patients were, age 79.5 months (2 to 204), weight 26.8 kg (4.4 to 102) and height 114.5 cm (55 to 185), the smallest patient was 2 months old, 4.4 kg in weight and 57 cm in height, a left pyeloplasty was performed. The adult patients were 31, 63 and 64 years old. We grouped our RALTS into gastrointestinal-hepatobiliary 123 (47.68%), urological 117 (45.35%), thoracic 10 (3.87% and oncological 8 (3.1%). We have

**40**

performed 46 different techniques, globally our conversion rate is 3.1%, the hemotransfusion rate is 4.2%, the mean postoperative stay is 2.5 days, and the mean follow-up is 40 months.

From the group of gastrointestinal-hepatobiliary robotic surgery, in order of frequency, the techniques performed were: primary fundoplication 50 (41.67%), redo fundoplication 20 (15.83%), gastrostomy 17 (14.16%), cholecystectomy 14 (11.67%), biliodigestive 7 (5%), being 5 resections of choledochal cysts with hepaticojejunostomy, a Kasai operation and a hepaticojejunostomy to manage the lesion of the left hepatic duct. Splenectomy 6 (5%), Malone operation 2 (1.67%) and various techniques 7 (5%), of single cases, duodenoplasty and adhesiolysis, gastric trichobezoar extraction, drainage of recurrent retrohepatic abscess after appendectomy, gastric antrum membrane resection, gastrojejunostomy de-derivation, and Ladd's Cure. In this group of gastro-intestinal-hepatobiliary robotic surgery, the conversion rate was 3.25%, intraoperative complications 1.6%, and postoperative complications 4%. In this group of RAS 14 different techniques were performed.

From the robotic urological surgery group, in order of frequency, the techniques performed were: pyeloplasty 26 (22.2%), ureteral reimplantation 21 (17.94%), nephrectomy 20 (17.1%), Mitrofanoff operation 8 (6.8%), nephroureterectomy 7 (6%), ureterostomy de-derivation and ureteral neo-reimplantation 5 (4.3%), nephro-cystolithotomy 5 (4.3%), varicocelectomy 5 (4.3%), release of extrinsic UPJ obstruction 4 (3.4%), inguinal hernioplasty 3 (2.56%) and various techniques 13 (11.1%) of single cases, ureteroureterostomy, augmentation cystoplasty, bladder neck closure, heminephroureterectomy, perirenal abscess drainage, colostomy closure, enterovesical fistula closure, Mitrofanoff review, ureterostomy and ureteropyelography, bilateral gonadectomy, duplicated ureter ureterostomy, hysterosalpingectomy, bladder wall biopsy. In this robotic urologic surgery group, the conversion rate was 0.85%, intraoperative complications 0.85%, and postoperative complications 1.7%. In this group of RAS 20 different techniques were performed.

In the robotic thoracic surgery group, in order of frequency, the techniques performed were: lobectomy 4 (40%), diaphragmatic plication or plasty 4 (40%), a bronchogenic cyst resection (10%) and a pleural biopsies (10%). In this robotic thoracic surgery group, the conversion rate was 20% and postoperative complications 10%. In this group of RAS 5 different techniques were performed.

In the robotic oncological surgery group, the techniques performed were adrenalectomy 2 (for adenoma and another for pheochromocytoma) and single techniques of, anterior mediastinal teratoma resection, Ewing tumor resection, Wilms tumor stage 3 resection in horseshoe kidney, partial gastrectomy for carcinoid tumor, retroperitoneal lipoma resection and conservative resection of ovarian cyst. In this robotic cancer surgery group, the conversion rate was 12.5%, and there were no complications. In this group of RAS 8 different techniques were performed. The cases of adult patients were pheochromocytoma, adrenal adenoma and carcinoid tumor.

Previously, we published our experience with RALTS, the first 186 surgeries [14], the first 4 cases of choledochal cyst resection [109], redo Nissen fundoplication [114] and in thoracic surgery [133].
