Çocuk Cerrahisinde Robotik Yardımlı Endoskopik Cerrahi Uygulamaları, Tek Merkez Deneyimi

Abstract

Giriş: Robot yardımlı laparoskopik cerrahi (RALS) tüm dünyada hızla yayılırken, pediatrik cerrahide bu yayılım birçok nedenden dolayı erişkin cerrahisine göre daha yavaştır. Bu çalışmada pediatrik robotik cerrahi olguları ile ilgili ilk deneyimlerimizi tartıştık. Hastalar ve Yöntem: Kasım 2017-Nisan 2022 tarihleri arasındaki robotik yardımlı endoskopik cerrahi vakaları retrospektif olarak incelendi. Hastaların tıbbi kayıtları, demografik özellikleri, cerrahi kayıtları ve takip süreleri retrospektif olarak incelendi. Bulgular: 48 çocuğun 27'si erkek, 21'i kızdı. Olguların en küçüğü 10 aylık, en büyüğü ise 17 yaşındaydı (ortalama 7,72±5,6, medyan 7). Ameliyat sonrası en kısa takip süresi 5 ay iken en uzun takip süresi 60 aydı. 48 pediatrik hastaya toplam 63 cerrahi işlem uygulandı. 17 piyeloplasti (sol 10, sağ 7), 9 Lich Gregoir ameliyatı (sağ 6, sol 3), 4 sol üreterovezikal bileşke obstrüksiyonu (UJO) nedeniyle üreteral reimplantasyon ve tapering, 3 Hemi nefrektomi, bir apendikovezikostomi, bir sağ üreteral reimplantasyon,11 Nissen fundoplikasyonu, 10 gastrostomi ve bir gastrojejunostomi, over kisti olan iki hastaya over koruyucu cerrahi uygulandı. Bir urakus remnant eksizyonu, bir adrenal kitle eksizyonu ve bir torasik outlet kitle eksizyonu yapıldı. Sonuç: Bu çalışma, ülkemizde pediatrik robotik cerrahi prosedürlerin geniş bir yelpazesini içeren ilk çalışmadır. Çocuk cerrahisinde robot yardımlı laparoskopik işlemler birçok cerrahi patolojide güvenle uygulanabilmektedir. Başlangıçta bazı basit cerrahi işlemlerin ardından en az 15 vakadan sonra daha karmaşık işlemlere geçilmesinin daha uygun olacağını düşünüyoruz.

Keywords

• Çocuklar
• Robot Yardımlı Cerrahi
• Minimal İnvaziv Cerrahi

Robotic Assisted Endoscopic Surgery Practices in Pediatric Surgery, Single Center Experience

Abstract

Objective: While robot-assisted laparoscopic surgery (RALS) is spreading rapidly all over the world, In pediatric surgery, this spread is slower than in adult surgery for many reasons. In this study, we discuss our initial experiences with pediatric robotic surgical cases. Material and Methods: Robotic-assisted endoscopic surgery between November 2017 and April 2022 was retrospectively reviewed. The medical records of the patients were reviewed retrospectively for some demographical features, surgical details, and follow-up time. Results: Of the 48 children, 27 were male and 21 were female. The youngest of the cases was 10 months old, while the oldest was 17 years old (mean 7.72±5.6, median 7). The shortest follow-up period after surgery was 5 months, while the longest follow-up was 60 months. A total of 63 surgical procedures were performed on 48 pediatric patients. 17 pyeloplasty (left 10, right 7), 9 Lich Gregoir operations (right 6, left 3), 4 ureteral reimplantation and tapering procedures due to left ureterovesical junction obstruction (UJO), 3 Hemi nephrectomy, one appendicovesicostomy, One right ureteral reimplantation, 11 Nissen fundoplication, 10 gastrostomy and one gastrojejunostomy, two ovarian sparing surgeries for ovarian cyst were performed. One urachal remnant excision, one adrenal mass excision, and one thoracic outlet mass excision were performed. Conclusion: This is the first study that includes a wide range of pediatric robotic surgical procedures in our country. Robotic-assisted laparoscopic procedures in pediatric surgery can be safely performed for many surgical pathologies. We think at the beginning some simple surgical procedures and then turning to the more complex procedures after at least 15 cases will be more appropriate.

Keywords

• Children
• Robot-Assisted Surgery
• Minimally Invasive Surgery

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