Robot-assisted esophageal surgery in children

BACKGROUND: The current literature contains a considerable number of reports on robot-assisted pediatric surgery, particularly regarding procedures performed on the genitourinary system. However, reports of operations on the digestive organs—especially the esophagus—are much less common.

AIM: To evaluate the efficiency and safety of the robot-assisted esophageal surgery.

METHODS: Аn incomparable clinical trial was conducted using the medical records of six patients who underwent robot-assisted thoracoscopic and laparoscopic esophageal surgery over a 24-month period starting in December 2022. All patients were treated in accordance with protocols approved by clinical guidelines or national recommendations for pediatric surgery. The indications for surgery included persistent anatomical and functional disorders unresponsive to conservative therapy, risk of future organ damage, and were determined following thorough examination. Robotic procedures were performed in one patient with a cystic duplication of the thoracic esophagus, two patients with achalasia of the cardiac section, and three patients with gastroesophageal reflux.

RESULTS: A total of 18 patients who underwent robot-assisted esophageal surgery were included in the study. Robotic procedures were performed in one patient with cystic duplication of the thoracic esophagus, five patients with achalasia of the cardiac section, and twelve patients with gastroesophageal reflux. The mean age at surgery was 7.6 ± 3.6 years (median = 7.0 [5.0; 10.0]), and mean body weight was 30.6 ± 20.4 kg (median = 23.0 [15.0; 50.0]). The average operative time was 132.7 ± 34.8 minutes (median = 125.0 [105.0; 155.0]). No intraoperative complications such as bleeding, organ perforation, or injury to adjacent structures were recorded, and there were no conversions to laparoscopic, thoracoscopic, or open surgery. The mean stay in the intensive care unit was 17.0 ± 7.8 hours (median = 22.0 [8.0; 24.0]), and the mean hospital stay was 4.0 ± 1.1 days (median = 4.0 [3.0; 5.0]). No significant postoperative complications or recurrence of symptoms were observed during follow-up, and all patients demonstrated normal digestive function throughout the observation period.

CONCLUSION: Robot-assisted thoracoscopic and laparoscopic surgical approaches are safe and effective methods for treating esophageal diseases in children.