Using robot-assisted surgery in gynecological diseases in children: a series of clinical cases

BACKGROUND: In the recent years, robot-assisted surgery has become widespread and has demonstrated the ability to overcome technical limitations of traditional laparoscopy and open surgery. Advantages of robotic surgery are: three-dimensional imaging and multiple magnification, increased maneuverability due to seven degrees of freedom of robotic instruments, tremor filtering, and improved ergonomics.

AIM: evaluate the safety and effectiveness of robot-assisted surgeries performed in pediatric patients with gynecological pathology.

METHODS: The present trial is a retrospective analysis of data from patients with gynecological diseases operated on in the Irkutsk State Regional Children’s Clinical Hospital. Versius robotic system (Cambridge Medical Robotics, Great Britain) was used.

RESULTS: Robot-assisted surgeries were performed in 5 patients who had the following diagnoses before surgery: ovarian teratoma (in 3 patients), ovarian cyst (in 2 patients, of which one had a concomitant formation in the form of a paratubic cyst). The size of the tumors, measured before surgery using ultrasound and computed tomography, was 1.8±2.4 cm (median 0.4 cm [0.4; 2.5]). Cystic formations were located mainly on the left (3:2). The average age of patients at the time of surgery was 12.2±2.0 years (median 11.0 years [10.0; 13.0]), the average body weight was 49.8±10.1 kg (median 52.0 [41.0; 56.0]). The lowest body weight of an operated child was 38 kg. Robot-assisted procedures included ovarian cystectomy (in 2 patients), teratoma enucleation (in 3 patients), and excision of a paratubal cyst (in 1 patient). The average surgery duration was 74.0±22.2 minutes (median 75.0 [70.0; 85.0]). During surgery, there were no complications like bleeding from the ovarian tissue or damage to neighboring organs. Cystic contents in all cases was clear liquid without pathological impurities. Histological findings established the following final diagnoses: “Serous ovarian cystadenoma” (in 2 patients), “Mature cystic teratoma” (in 1), “Mature cystic-solid teratoma” (in 2), “Paratubal cyst” (in 1). The length of stay of patients in the intensive care unit was 3.2±0.4 hours (median 3.0 [3.0; 3.0]), hospitalization lasted for 4.0±1.5 days (4.0 [3.0; 4.0]). Ultrasound examination in 1, 3 and 6 months after the surgery revealed no signs of recurrence of the disease.

CONCLUSION: Our trial has reached the main goal―to provide 3D visual control of the targeted anatomic area of surgical intervention and safe removal of pathological formations with preservation of the ovarian tissue. Thus, robot-assisted manipulations in girls with gynecological pathologies are possible.