Robot surgery safe in kids, but outcomes no better

Robotic surgery is safe for use in children, but there's little evidence that outcomes for this type of surgery are any better than they are with standard operations, the authors of a new review of medical studies published in Pediatrics conclude.

Robotic surgery-in which a surgeon controls robotic instruments from outside the patient's body, in some cases even from far away-offers several advantages, including ways to eliminate hand tremors and improve the surgeon's vision and depth perception, Dr. Goedele van Haasteren of Hayes Inc. Independent Health Technology Assessment Company in Lansdale, Pennsylvania and her colleagues note. These advantages can be particularly important when performing complex procedures in children's smaller, more delicate bodies.

Surgeons first attempted robotic surgery in a child in 2001, van Haasteren and her team write in their report, and now robots are being used to perform several different procedures in children.

Such procedures, however, require hospitals to buy expensive equipment - which they often tout in advertising. One such system, the da Vinci Surgical System, costs $1 million, with a $100,000 annual maintenance fee. Just that can add an average of $2,800 to each case.

Currently, the researcher said, robotic surgery is most commonly used in pediatric patients for Nissen fundoplication, a procedure to treat severe heartburn, to repair a heart defect known as patent ductus arteriosus; and for fixing some birth defects.

The researchers looked at all existing medical literature on pediatric robotic surgery, including eight case series reports and five studies comparing robotic surgery to standard procedures.

Overall, the researchers found, when performed by experienced surgeons, robotic procedures were safe and feasible, although there was no evidence that patient outcomes were any better than they were with standard procedures.

"It's not an easy technology, but it can help people in very complicated procedures," noted van Haasteren. "It can be life-saving in such circumstances."

The future of the technology in pediatric patients, she added, is likely to be for performing such complex procedures. Robotic surgical technology also offers an excellent way to teach physicians to perform surgery by operating on "virtual" patients, according to van Haasteren.

She and her colleagues conclude that "in view of longer operating times, higher operating costs, and the lack of clinical advantage, robotic surgery does not currently represent a general alternative to conventional, minimally invasive surgery."

SOURCE: Pediatrics, December 2009.