ROBOT-ASSISTED SURGERY OF THE ESOPHAGUS IN CHILDREN

Introduction. There are many reports on robotic-assisted pediatric surgery in the modern literature, especially regarding procedures performed on the genitourinary system. Surgeries on the digestive system, especially on the esophagus, are less common. The aim of our study is to report the first experience of robotic surgery of the esophagus and discuss the most appropriate indications for robotic-assisted interventions on this organ.

Materials and methods. In a retrospective study, we analyzed the medical records of 6 patients who underwent robotic-assisted thoracoscopic and laparoscopic surgical interventions on the esophagus over 12 months, starting in December 2022. Robotic procedures were used in 1 patient with cystic duplication of the thoracic esophagus, 2 patients with achalasia of the cardiac esophagus, and 3 patients with gastroesophageal reflux. The data obtained from the analysis of treatment results were supplemented by a literature review.

Results. The total number of patients who underwent robot-assisted esophageal surgery was 6. The average age of patients at the time of surgery was 7.6±3.6 years (median – 8.5 [4.5; 10.5] years). The average weight of patients at the time of surgery was 35.3±19.9 kg (median – 35.0 [17.0; 54.5] kg). The lowest body weight of a child who underwent robot-assisted surgery was 10 kg, the lowest age was 2 years. The average surgery time was 147.5±38.9 min (median – 140.0 [116.5; 180.0] min). The average robot docking time was 15.0±3.2 (median - 15.0 [14.0; 16.5]) min. The surgeries were not accompanied by intraoperative complications such as bleeding, organ perforation, trauma to adjacent anatomical structures. Also, no conversions to laparoscopic, thoracoscopic or open surgical interventions were recorded. The average length of stay in the intensive care unit was 23.0±1.5 (median – 23.5 [22.5; 24.0]) hours. The average length of hospitalization was 4.0±1.5 (median – 4.0 [3.0; 5.0]) days.

In the late period after the operations, no significant complications in the form of relapse of disease symptoms were noted. During the entire observation period, patients demonstrated no problems with digestion.

Conclusion. The use of robot-assisted thoracoscopic and laparoscopic surgical access is a safe and effective method for treating esophageal diseases in children.