Early and Long-term Complications of Robotic Assisted Laparoscopy in Infants and Children.

Autor: Di Fabrizio D; Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK., Alizai NK; Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK., Najmaldin AS; Department of Paediatric Surgery, Leeds Teaching Hospitals, The General Infirmary, Leeds, UK. Electronic address: azad.najmaldin@nhs.net.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2023 Sep; Vol. 58 (9), pp. 1832-1837. Date of Electronic Publication: 2023 Mar 04.
DOI: 10.1016/j.jpedsurg.2023.02.061
Abstrakt: Background: Robotic-assisted laparoscopy still lacks wide acceptance in infants and children. We developed the service and report the largest single institution experience of complications over a period of 11 years.
Methods: Between March 2006 and May 2017, consecutive infants and children who underwent robotic assisted laparoscopy under the care of two laparoscopic surgeons were studied. Data for patients, surgeons, year of surgery, operation, and timing, nature, grades of complications were assessed.
Results: A total of 601 robotic procedures (45 different types) were carried out in 539 patients. Of these 31 (5.8%) were converted, none for operative complications. These and another 4 with complicated co-morbidity were excluded, leaving 504 patients for further analysis. There were 60 (11.9%) complications in 57 (11.3%) patients. Mean (SD) age was 7.7 years -/+5.1 with the youngest being 4 weeks. Concomitant or bilateral robotic and non-robotic procedures took place in 8.1% and 13.3% of patients respectively. Significant medical co-morbidity and abdominal scarring were present in 29% and 14.9% of patients respectively. Complications occurred in theatre 1.6%, hospital 5.6%, 28 days 1.2%, and late 3.6%. Mean follow up was 7.6 years -/+ 3.1 SD. Over-all postoperative complication rate was 10.3%: CD grade I 6.5% (33), II 0.6% (3), and IIIa/b 3.2% (16) which included 1.4% (7) re-do surgery. Most (11/16) grade III occurred late. There were no bleeding, grade IV or V complications, surgical mortality, or technology related complications.
Conclusions: Complications are low even during the learning phase and while developing the new technique. Most complications occurred early and were minor. Most high-grade complications presented late.
Levels of Evidence: 2B.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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