Donatella Di Fabrizio1,2, Thomas Cundy1,3, Naved Alizai1, Azad Najmaldin1
1Leeds General Infirmary, Leeds, United Kingdom. 2University of "Gabriele D'Annunzio", Chieti - Pescara, Italy. 3University of Adelaide, Adelaide, Australia


Aim: To present early and late complications of robotic assisted laparoscopy in children.

Methods: All children who underwent robotic assisted laparoscopic surgery under the care of two laparoscopic surgeons between March 2006 and May 2017 were included. Three arms of the da Vinci system and an open technique laparoscopy were used in all cases (12 or 8mm optic and 8 or 5mm working ports). An additional laparoscopic port and a retractor were used when necessary. Theatre setup/team changed not infrequently throughout the study period. All patients had regular follow. Data was collected prospectively.

Results: There were 536 procedures in 522 children (6 re-do, 8 concomitant). The procedures were urological in 51.5%, hepatobiliary and spleen 26.1% and gastrointestinal 22.4% (26 different procedures).The median age was 7.3 years (4 weeks - 16 years, 7% less than one, smallest 4.2kg). 18.6% had a significant comorbidity, 15.9% previous surgery and abdominal scarring,  and 5.8% concomitant non-robotic procedures. The procedure was converted in 5.4% (29), none for surgical complications. In theatre complications occurred in 1.3 % (7) - of these, 3 were minor, 3 gastrostomy related, 1 damaged vagus nerve. Early postoperative  complications occurred in 3.7% (20) - of these, 8 required further procedure (3 laparoscopy / laparotomy, 5 endoscopy) and the remainder were treated conservatively. Throughout the study period 2.4% (13) developed complications . These included redo-surgery 6, other surgical procedures 4, endoscopy 1, asymptomatic renal cyst 2. The rates and nature of complications did not corelate significantly with the patients age, timing of surgery or operator.

Conclusions: In the hands of laparoscopic surgeons, morbidity of robotic assisted surgery appears low even during the learning curve. The importance of careful planning cannot be overemphasised.