single-port robotic surgery in children · •mitrofanoff •female: age 10y ©2015 mfmer | slide-8...
TRANSCRIPT
©2015 MFMER | slide-1
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