Page 33 - Read Online

Page 4 of 12 Navarrete-Arellano. Mini-invasive Surg 2020;4:9 I http://dx.doi.org/10.20517/2574-1225.2019.70

studies, X-rays, ultrasound, CT scan image, angiographic study, and histopathology, according to the
patient.

The surgeries were performed by MITS assisted by robot. We used the “da Vinci surgical system Version Si”
(Intuitive Surgical, Inc., Sunnyvale, CA. USA).

We use four or five trocars (three of four robotics and one laparoscopic). To collapse the hemithorax lung
to operate, in patients younger than six years, we used CO at 6 mmHg of pressure and flow of 1-4 liters per
2
minute, while, in patients older than six years, selective intubation of the contralateral bronchus was used.

Registered variables included demographic data, diagnosis, surgical technique, total time, time of console
surgery, bleeding, hemotransfusions, conversions, complications, PO stay, and follow-up. The data were
entered into a spreadsheet in Microsoft Office Excel 2013.

[23]
Seven cases are part of the statistics of our published series of the first three years of robotic surgery .

Measures of central tendency were used. In relation to ethical considerations of the study, being of an
observational nature, it was not necessary to obtain the informed consent for the patients to enter the study.
The Research Ethics Committee of the Hospital evaluated and approved the study. To perform the medical
and surgical procedures, we obtained the informed consent in writing from the parents or guardians.

We carried out a detailed non-systematic review of previous publications in PubMed on thoracic pathology
treated with robotic surgery in the pediatric population, with the following four search strategies (at:
https://www.ncbi.nlm.nih.gov/pubmed/): (1) robot-assisted thoracoscopic surgery + thoracic robotic
surgery + children; (2) robot-assisted thoracoscopic surgery + children; (3) thoracoscopic robotic surgery +
children; and (4) robotic surgery thoracic + children.

RESULTS
We treated 11 patients with thoracic pathology, six male and five female. The average age was 5.7 years (range
6 months to 15 years), the average weight was 21.34 kg (range: 5.93-60 kg), and the average height was 107 cm
(range: 66-176 cm). The diagnoses were three congenital cystic adenomatoid malformation (CCAM) and
an intralobar sequestration; three right diaphragmatic paralysis and a diaphragmatic eventration; and one
case each of mediastinal teratoma, Ewing’s tumor of the fourth left rib, and pulmonary tuberculosis. The
surgeries performed were: four lobectomies (36.36%), four diaphragmatic plications (36.36%), two tumor
resections (18.2%), and one pleural and lung biopsies (9.1%).

The following average values were found: console surgery time, 166.45 min (range: 25-314 min); bleeding,
42.27 mL (range: 0-150 mL); and PO stay, 3.6 days (range: 1-12 days). Conversions and PO complications
were reported in one patient, and there were no intraoperative (IO) complications and mortality.
Hemotransfusions were reported in one patient: a 10-month-old girl, weighing 5.93 kg and 66 cm tall,
who entered the operating room with low hemoglobin, the diagnosis of CCAM, and underwent lower
right lobectomy. She required 314 min of console surgery time, presented 40 mL of bleeding, and was
hemotransfused in the immediate PO period. Her PO stay was three days. This is our smallest patient by
weight and height.

The patient with Ewing’s tumor, from the left hemithorax, was a seven-year-old boy, weighing 21 kg and
was 102 cm tall. The patient initially underwent an open incisional biopsy, through a 5-cm incision over
the tumor area, obtaining the histopathological diagnosis of Ewing’s tumor of the anterior arch of the