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Single-port Robotic Surgery in Children

Candace F. Granberg, MD and Patricio C. Gargollo, MD

Mayo ClinicRochester, MN

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Evolution of Pediatric Urologic Surgery

Single-incision surgery

Camera port

Standard lap/robotic ports

I don’t like

visible

incisions…

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Evolution of Pediatric Urologic Surgery

Single-incision surgery

Camera port

Standard lap/robotic ports

Camera port

HIdES* ports

*Gargollo, J Urol, 2011

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Evolution of Pediatric Urologic Surgery

Single-incision surgery Single-incision surgery???

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Single-port (SP) robotic platform

• FDA clearance for Urology in 2018

• 2.5cm, 4-channel port

• 12x10mm articulating camera

• 6mm multi-wristed instruments

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Objectives

• Demonstrate feasibility of SP robotic platform in pediatric population

• Report intraoperative details, perioperative outcomes

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First SP robotic pediatric series

• Pyeloplasty

• 2 female: age 10y, 6y

• 1 male: age 23 months

• Mitrofanoff

• Female: age 10y

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• 2.5cm incision in Pfannenstiel line

• Retract port = increase working distance

• 10cm needed for deploying elbows, wristingof instruments

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SP robotic platform: instruments

• Maryland dissecting forceps

• Cadiere forceps

• Wristed needle driver

• Curved scissors

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Results: Pyeloplasty

• All completed via single-port

• No complications

• Median operative time: 120 minutes

• EBL: <5mL

• liposomal extended-release bupivacaine (EXPAREL®) to incision for 10y, 0.25% bupivacaine for others

• No opioids

• Dismissed <24hrs on acetaminophen, ibuprofen PRN

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Results: Mitrofanoff

• SP plus 5mm assist port

• No complications

• Operative time: 240 minutes

• EBL: <5mL

• Exparel

• No opioids

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SP robotic platform: Technical considerations

• Visualization:

• Excellent; no different than with HIdES

• Instrument use/movement:

• No difficulty

• Deploy, triangulate without clashing in the older children

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SP robotic platform: Limitations

• Difficult in smaller patient

• <10cm working distance cannot deploy instrument elbows

• No wristing

• Working in straight-line

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SP robotic platform: Limitations

• Loss of insufflation with use of lap instruments

• Passing needles

• 5mm laparoscopic suction

• Seal on port doesn’t maintain closed system

• Rapid loss of working space

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SP robotic platform: Recommendations

• Limit use to older children, teenagers

• Need 10cm working distance

• Can use Gel-Port to extend

• Place needles into abdomen after incision, before port placement

• SP-specific suction device (but consider cost)

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Conclusions

• Single-port robotic surgery is feasible in pediatric patients

• Patient selection is key

• Improvements to platform are needed to expand use

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@candacegranberg @pgargollo