USING ROBOT-ASSISTED SURGERY FOR TREATMENT OF GYNECOLOGICAL DISEASES IN CHILDREN

Introduction. This study aims to report the initial experience of robot-assisted operations performed in pediatric patients with gynecological pathology.

Material and methods. The study included all children under 18 years of age who underwent surgery using robot-assisted surgery for gynecological indications. Exclusion criteria were patients over 18 years of age, as well as all gynecological surgical diseases for which robot-assisted surgery was not used. Four patients met these criteria. Preoperative examination included abdominal ultrasound, abdominal and pelvic computed tomography, and magnetic resonance imaging. Serum tumor markers such as beta-human chorionic gonadotropin (β-HCG), alpha-fetoprotein (α-FP), cancer antigen 125 (Ca125) were examined in all patients with adnexal neoplasms. The following diagnoses were established before the operation: ovarian cyst (n = 2), ovarian teratoma (n = 2). One patient with an ovarian cyst had a concomitant formation in the form of a paratubal cyst. The size of the tumors, measured before the operation using ultrasound and CT, was 1.8 ± 2.4 cm (median - 0.4 [0.4; 2.5] cm). Cystic formations were predominantly located on the left (3: 2).

Results. The total number of patients who underwent robot-assisted surgeries was 5. The average age of patients at the time of surgery was 12.2±2.0 years (median – 11.0 [10.0; 13.0] years). The average weight of patients at the time of surgery was 49.8±10.1 kg (median – 52.0 [41.0; 56.0] kg). The lowest body weight of a child who underwent robot-assisted surgery was 38 kg. Robot-assisted procedures included: ovarian cystectomy (n = 2), teratoma enucleation (n = 3), and paratubal cyst excision (n = 1). The average duration of surgery was 74.0±22.2 min (median – 75.0 [70.0; 85.0] min). During the surgical intervention, no complications such as bleeding from the ovarian tissue or damage to adjacent organs were noted. In all cases, the cyst contents were transparent fluid without pathological impurities. Histological examination established the final diagnosis: serous cystadenoma of the ovary (n = 2), mature cystic teratoma (n = 1), mature cystic-solid teratoma (n = 2), paratubal cyst (n = 1). The duration of the patients' stay in the intensive care unit was 3.2 ± 0.4 hours (median - 3.0 [3.0; 3.0] hours). The duration of hospitalization was 4.0 ± 1.5 days (4.0 [3.0; 4.0] days). According to ultrasound examinations performed 1, 3 and 6 months after surgery, no signs of recurrence of the disease were found.

Conclusion. The results of the study served as the basis for concluding that it is possible to perform robot-assisted procedures in girls with gynecological pathology, since the main goal was achieved - providing 3D visual control of the target anatomy of surgical intervention and safe removal of the pathological formation while preserving ovarian tissue, due to the maneuverability of robotic instruments and improved visualization.