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Navarrete-Arellano. Mini-invasive Surg 2020;4:9 I http://dx.doi.org/10.20517/2574-1225.2019.70 Page 3 of 12
[9]
In the adult population, Melfi et al. published the first report on robotic surgery for thoracic diseases, with
encouraging results in their preliminary experience. They believed that robotic procedures are technically
feasible. Theirs was the first robotic lobectomy in Europe (February 2001, and published in 2002).

In the United States, the first pulmonary lobectomy performed with robotic assistance was reported in July
[10]
2003, in a 48-year-old woman with lung cancer .
The first publication on pulmonary lobectomy with robotic assistance, including pediatric cases, is from
[11]
Park et al. , in 2006. They concluded that RATS lobectomy is feasible and safe, and the usefulness and
advantages of robotic assistance for lobectomy require further refinement and study of the technique.

[12]
Toker and his group started with a thoracic robotics program after an established experience of video-
assisted thoracic surgery (VATS). The idea for a thoracic robotic program was based on the anatomical
difficulties of some thoracoscopic lung resections and the superior capabilities of the robotic articulated
instruments.

The main advantages of using a robotic device are: (1) the precision of the instrument and improved
dexterity due to the use of “wristed” instruments; (2) three-dimensional imaging, with improved ability to
locate blood vessels, nerves, and tissues; and (3) the surgeon’s console, which reduces fatigue and allows for
[13]
tremor-free manipulation .
The improvements with robotic assistance offer technical capabilities beyond the existing threshold limits
of human performance for surgery within restricted work spaces in children; the camera is controlled by
[14]
the primary surgeon; and articulated instruments allow dissection and precise anastomosis . The above
are advantages for the surgeon, which benefit the patient.

RATS is gaining more acceptance for the adult population and recently large series have been reported on
[17]
lobectomy [15,16] and excision of the mediastinal cyst .

[18]
The first robotic procedure in children was fundoplication, and was carried out by Meininger et al. in
July 2000 and reported in 2001.

The safety of robotic-assisted surgery in children is reported to be similar to open procedures, and the
outcomes are at least equivalent to standard laparoscopy .
[19]

Very few cases of RATS have been reported in children. The first publications of RATS in children were in
the area of cardiovascular surgery [20,21] .

[22]
Ballouhey et al. , in 2015, published on 11 patients treated with RATS at two pediatric surgery centers
over a period of six years. Their conclusions were RATS for newborns and infants is still very challenging;
these patients are not good candidates for this approach; and the most appropriate procedures are the
removal of mediastinal cysts in children weighing more than 20 kg.

The objective of this article is to inform about our experience in MITS assisted by robot in children. In
addition, a current analysis is carried out on this topic.

METHODS
Observational, prospective, and longitudinal studies were performed for pediatric patients with thoracic
pathologic treated with RATS, from March 2015 to April 2019. The diagnosis was made with laboratory